不同起始剂量替考拉宁对革兰阳性菌感染重症肺炎患者的效果观察

The effects of different initial doses of teicoplanin in patients with severe pneumonia associated with Gram positive bacteria

目的探讨不同起始负荷剂量替考拉宁治疗革兰阳性菌感染重症肺炎患者的临床效果。方法选取2016年1月至2017年6月入住我院ICU的重症肺炎患者80例作为研究对象,随机分为观察组与对照组,两组患者均采用替考拉宁进行治疗,观察组起始剂量为800 mg,每天2次,对照组起始剂量为400mg,每天2次,比较两组患者的炎症指标水平、临床疗效、细菌清除率以及不良反应发生情况。结果 80例重症肺炎患者共分离出革兰阳性菌86株,构成比位居前三位的分别是耐甲氧西林金黄色葡萄球菌(43.02%)、凝固酶阴性葡萄球菌(26.74%)、肠球菌属(17.44%)。治疗前,两组的WBC、CRP、PCT水平差异均无统计学意义(Ps>0.05);治疗后,两组的WBC、CRP、PCT水平均降低,且观察组各指标水平低于对照组,差异有统计学意义(Ps<0.05)。观察组总有效率为90.00%,对照组总有效率为70.00%,两组总有效率差异有统计学意义(P<0.05)。观察组细菌清除率为82.50%,对照组细菌清除率为62.50%,两组细菌清除率差异有统计学意义(P<0.05)。观察组不良反应发生率为5.00%,对照组不良反应发生率为7.50%,两组的不良反应发生率差异无统计学意义(P>0.05)。结论 800mg起始负荷剂量替考拉宁治疗革兰阳性菌感染重症肺炎的临床疗效较好,细菌清除率更高,且不增加不良反应的发生。

Objective To explore the clinical effects of different initial loading doses of teicoplanin in the treatment of severe pneumonia associated with Gram positive bacteria.Methods 80 patients with severe pneumonia in the ICU of our hospital from January 2016 to June 2017 were enrolled and randomly divided into the observation group or the control group.Both groups were given teicoplanin,with the initial dosage for the observation group being 800 mg,bid,while that for the control group being 400 mg,bid.The clinical efficacy,bacterial clearance rate and the incidence of adverse reactions were compared between the two groups.Results 86 strains of Gram positive bacteria were isolated from the 80 patients with severe pneumonia;the top three were methicillin resistant Staphylococcus aureus（43.02%）,coagulase negative Staphylococci（26.74%）and Enterococci（17.44%）.Before treatment,there were no significant differences in the levels of WBC,CRP and PCT between the two groups（Ps0.05）;after treatment,the levels of WBC,CRP and PCT decreased in both groups,which were lower in the observation group than in the control group,with statistically significant differences（Ps0.05）.The total efficiency rate was 90.00% in the observation group vs 70.00%in the control group,with statistically significant difference（P〈0.05）.The bacterial clearance rate in the observation group was 82.50%,and that in the control group was 62.50%,with statistically significant difference（P〈0.05）.Conclusion Teicoplanin at an initial loading dose of800 mg has better efficacy in the treatment of severe pneumonia with higher bacterial clearance rate and no more adverse reactions.