卡泊芬净注射剂联合伏立康唑片治疗肾移植患者术后医院获得性肺炎的临床研究

Clinical trial of caspofungin injection combined with voriconazole tablets in the treatment of hospital acquired pneumonia after renal transplantation

目的观察卡泊芬净注射剂联合伏立康唑片治疗肾移植患者术后医院获得性肺炎(HAP)的临床疗效及安全性。方法将80例肾移植术后HAP患者随机分为对照组和试验组,每组40例。对照组予以伏立康唑每次200 mg,q12 h,口服;试验组在对照组治疗的基础上,予以卡泊芬净首剂70 mg,第1天,静脉输注,随后以50 mg的剂量维持治疗,第2～14天,qd,静脉输注。2组患者均治疗14 d。比较2组患者的临床疗效、血氧饱和度(SaO_2)、氧分压(PaO_2)和氧合指数(OI)、二氧化碳分压(PaCO_2),以及药物不良反应的发生情况。结果治疗后,试验组和对照组的总有效率分别为92.50%(37例/40例)和77.50%(31例/40例),差异有统计学意义(P<0.05)。治疗后,试验组和对照组的pH分别为(7.40±0.04)和(7.32±0.06),SaO_2分别为(95.05±1.45)%和(92.32±1.51)%,PaCO_2分别为(31.63±2.85)和(34.43±2.85)mmHg,PaO_2分别为(84.17±3.12)和(79.67±2.34)mmHg,OI分别为(235.04±4.94)%和(207.24±6.59)%,差异均有统计学意义(均P<0.05)。2组患者的药物不良反应均以呕吐和眩晕为主。试验组和对照组的总药物不良反应发生率分别为7.50%和5.00%,差异无统计学意义(P>0.05)。结论卡泊芬净注射剂联合伏立康唑片治疗肾移植患者术后HAP的临床疗效确切,其能有效地稳定患者的血气指标,且不增加药物不良反应的发生率。

Objective To observethe clinical efficacy and safety of caspofungin injection combined with voriconazole tablets in the treatment of hospital acquired pneumonia （HAP） after renal transplantation. Methods A total of 80 patients with HAP after renal transplantation were randomly divided into control and treatment groups with 40 cases per group. Control group was treated with voriconazole 200 mg per time, q12 h, orally. Treatment group received the first dose of capoprofen 70 mg by intravenous infusionon the first day, followed by maintenance treatment with a dose of 50 mg, and intravenous infusion from day 2 to day 14. Two groups were treated forl4 days. The clinical efficacy, blood oxygen satu- ration （ SaO2 ）, oxygenation index （ OI ）, carbon dioxide partial pressure （PaCO2 ） and oxygen partial pressure （PaO2 ）, and adverse drug reac- tions were compared between two groups. Results After treatment, the total effective rates of treatment and control groups were 92. 50% （37 cases/40 cases） and 77.50% （31 cases/40 ca- ses） with significant difference （ P 〈 0. 05 ）. After treatment, the main indexes of treatment and control groups were compared： pH were （7.40±0.04） and （7.32±0.06）, SaO2 were （95.05 ±1.45）% and （92.32 ± 1.51）%, PaC02 were （31.63±2. 85） and （34.43 ±2. 85）mmHg, Pa02 were （84. 17 ±3.12） and （79.67±2.34）mmHg,OI were （235.04 ±4. 94） % and （ 207.24 ± 6.59 ） %, the differences were statistically significant （ all P 〈 0. 05 ）. The adverse drug reactions of two groups were vomiting and vertigo. The total incidences of adverse drug reactions were 7.50% and 5.00% without significant difference （ P 〉 0, 05）. Conclusion Caspofungin injection combined with vori- conazole tablets has a definitive clinical efficacy in the treatment of HAP after renal transplantation, which can signifi- cantly stabilize the blood gas indexes of patients, without increasing the incidence of adverse drug reactions.