非发酵菌血流感染88例治疗经验分析

Analysis Treatment Experience of 88 Cases of Non-fermentative Bacteria Bloodstream Infection

目的:分析呼吸内科与内科重症监护室(MICU)非发酵菌(Non-fermentative bacteria)血流感染患者经验性使用碳青霉烯类药物和酶抑制剂合剂治疗的临床效果。方法:回顾性分析本院2014年10月-2016年10月呼吸内科与MICU非发酵菌血流感染患者88例的临床资料,按照治疗用药方案不同将其分为碳青霉烯组42例和酶抑制剂组46例。两组患者均给予常规治疗,酶抑制剂组加用头孢哌酮治疗,碳青霉烯组加用亚胺培南治疗。比较两组临床疗效、不良反应及治疗前后的降钙素原和肾功能(肌酐)。结果:酶抑制剂组治疗总有效率为82.61%,高于碳青霉烯组的61.90%(P<0.05);酶抑制剂组死亡率为6.52%,低于碳青霉烯组的23.81%(P<0.05)。治疗后两组降钙素原、肌酐水平均较治疗前降低(P<0.05),且酶抑制剂组降钙素原、肌酐水平均低于碳青霉烯组(P<0.05)。碳青霉烯组不良反应发生率为26.19%(11/42),高于酶抑制剂组的19.56%(9/46),但比较差异无统计学意义(P>0.05)。结论:酶抑制剂合剂可以作为碳青霉烯类药物的替代选择,在血流感染治疗过程中发挥重要作用。

Objective:To analyze the clinical effect of carbapenem drugs and enzyme inhibitor mixture in treatment of non-fermentative bacteria bloodstream infection in respiratory medicine and medical intensive care unit(MICU).Method:The clinical data of 88 patients with non-fermentative bacteria bloodstream infection in respiratory medicine and MICU in our hospital from October 2014 to October 2016 were analyzed retrospectively,according to the different treatment scheme,they were divided into 42 cases of carbapenem group and 46 cases of enzyme inhibitor group.They were treated with routine treatment,enzyme inhibitor group was treated with Cefoperazone,and carbapenem group was treated with Imipenem.The clinical effects,adverse reactions,procalcitonin and renal function(creatinine)before and after treatment were compared between two groups.Result:The total effective rate of enzyme inhibitor group was 82.61%,which was higher than 61.90%of carbapenem group(P<0.05),the mortality of enzyme inhibitor group was 6.52%,which was lower than 23.81%of carbapenem group(P<0.05).After treatment,the levels of procalcitonin and creatinine in two groups were lower than those of before treatment(P<0.05),and the levels of procalcitonin and creatinine in enzyme inhibitor group were lower than those of carbapenem group(P<0.05).The incidence of adverse reactions in carbapenem group was 26.19%(11/42),which was higher than 19.56%(9/46)of enzyme inhibitor group,the difference was not statistically significant(P>0.05).Conclusion:Enzyme inhibitor mixture can be used as a substitute for carbapenems,and can play an important role in the treatment of bloodstream infection.