雾化吸入阿米卡星对治疗老年重症社区获得性肺炎的疗效观察

Observation of curative effect of atomizing inhalation of Amikacin in the treatment of severe community-acquired pneumonia in the elderly

目的通过雾化吸入阿米卡星治疗老年重症社区获得性肺炎(severe community-acquired pneumonia,SCAP),探讨治疗的有效性和安全性。方法将2015年1月至2016年12月郑州大学附属洛阳中心医院急诊重症监护病房(emergency intensive care unit,EICU)收治的老年SCAP患者106例分为雾化组和对照组各53例,两组年龄、性别、基础疾病、病原学构成及对阿米卡星的敏感性差异均无统计学意义(P>0.05)。对照组行常规治疗,雾化组在常规治疗基础上行阿米卡星雾化吸入,对两组机械通气时间、住重症监护病房(intensive care unit,ICU)天数、住院天数、抗生素使用时间,肺部感染评分(Clinical Pulmonary Infection Score,CPIS)、急性生理与慢性健康状况评分(Acute Physical and Chronic Health EvaluationⅡ,APACHEⅡ)评分、细菌清除率、治疗总有效率、28 d病死率及不良反应进行分析。结果雾化组机械通气时间、住ICU天数、住院天数、抗生素使用时间分别为(7.98±2.36)d、(9.81±1.90)d、(12.68±1.65)d、(11.21±1.40)d,短于对照组的(9.62±2.70)d、(12.34±2.72)d、(14.94±2.73)d、(13.77±2.25)d,差异有统计学意义(P<0.05);雾化组第7 d CPIS评分及APACHEⅡ评分较对照组及入院时明显减低,差异有统计学意义(P<0.05);雾化组细菌清除率及治疗总有效率分别为76%、81.13%,均高于对照组的56.52%、62.26%,差异有统计学意义(P<0.05);雾化组28 d病死率略低于对照组,不良反应发生率较低,两组28 d病死率与不良反应发生率差异无统计学意义(P>0.05)。结论雾化吸入阿米卡星治疗老年SCAP患者安全有效,值得推广。

Objective The efficacy and safety of the treatment were discussed by atomizing inhalation of Amikacin in the treatment of elderly patients with severe community-acquired pneumonia（ SCAP）. Methods From January 2015 to December 2016,106 cases of elderly patients with SCAP admitted to the department of emergency intensive care unit（ EICU） in Luoyang Central Hospital affiliated to Zhengzhou University were randomly divided into the atomization group and the control group of 53 cases. There was no statistically significant difference between the two groups of age,gender,underlying disease,etiology and sensitivity to Amikacin（ P〈0. 05）. Control group was treated with conventional treatment,and atomization group was inhaled on the basis of conventional treatment. On two groups of mechanical ventilation time and ICU days,hospitalization days,antibiotic use time,Clinical Pulmonary Infection Score（ CPIS） and acute Physical and Chronic Health Evaluation Ⅱ（ APACHE Ⅱ）,bacterial clearance rate and fatality rate,total effective rate of treatment,and28 days adverse reactions were analyzed. Results Mechanical ventilation time,ICU days,hospitalization days and antibiotic use time of Atomization group were（ 7. 98 ± 2. 36） d,（ 9. 81 ± 1. 90） d,（ 12. 68 ± 1. 65） d,（ 11. 21 ± 1. 40） d respectively. Control group was（ 9. 62± 2. 70） d,（ 12. 34 ± 2. 72） d,（ 14. 94 ± 2. 73） d,（ 13. 77 ± 2. 25） d. The data of the atomization group was shorter than that of control group. The difference was statistically significant（ P〈0. 05）. The 7 th day CPIS score and APACHE Ⅱ score of atomization group were significantly lower than that of control group and the admission,the difference was statistically significant（ P〈0. 05）. The total effective rate and bacterial clearance in the atomization group was 76% and 81. 13%,respectively,which was higher than 56. 52% and 62. 26%of the control group,and the difference was statistically significant（ P〈0. 05）. The mortality rate of 28 d in atomization group was slightly lower than that in control group,and the incidence of adverse reactions was low. There was no statistically significant difference betweenthe two groups＇ 28 d mortality and the incidence of adverse reactions（ P〈0. 05）. Conclusion It is safe and effective of aerosolized Amikacin in the treatment of SCAP in the elderly and worth popularizing.