替加环素治疗老年脑梗死合并泛耐药鲍氏不动杆菌肺部感染的应用效果

Effect of tigecycline on treatment of pan-drug resistant Acinetobacter baumannii pulmonary infection in elderly patients with cerebral infarction

目的探讨替加环素在老年脑梗死合并泛耐药鲍氏不动杆菌肺部感染患者治疗中的应用效果。方法选取2010年6月-2019年6月海南省干部疗养院收治的脑梗死合并泛耐药鲍氏不动杆菌肺部感染患者临床资料进行回顾性分析。共纳入102例患者,根据治疗方法不同分为研究组和对照组,对照组58例给予头孢哌酮舒巴坦钠治疗,研究组44例在对照组基础上再采用替加环素治疗。比较两组临床治疗疗效、细菌学疗效、住院时间及病死率,治疗前后肺功能及血气指标变化、炎症指标变化,神经功能、病情程度变化。结果研究组治疗总有效率77.27%高于对照组的48.28%,细菌清除率75.00%高于对照组的43.10%(P<0.05);研究组住院时间、28 d病死率少于对照组(P<0.05)。治疗后7 d,研究组第一秒用力呼气容积占用力肺活量比值(Forced expiratory volume in one second%,FEV1%)、动脉血氧分压(Partial pressure of oxygen,PaO2)高于对照组,二氧化碳分压(Partial Pressure of Carbon Dioxide,PaCO2)、血清降钙素原(Procalcitonin,PCT)水平、白细胞计数(White blood celt count,WBC)水平、美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分、急性生理与慢性健康评分(Acute Physiology and Chronic Health Evaluation,APACHEⅡ)低于对照组(P<0.05)。结论替加环素能有效提高老年脑梗死合并泛耐药鲍氏不动杆菌肺部感染治疗疗效,减轻炎症反应,提高肺功能,促进神经功能恢复和疾病康复。

OBJECTIVE To explore application effect of tigecycline in treatment of pulmonary infection in elderly cerebral infarction(CI)patients combined with pan-drug resistant Acinetobacter baumannii(PDR-AB)infection.METHODS The clinical data of 102 patients with CI and PDR-AB pulmonary infection who were admitted to Hainan Cadre Sanatorium from June 2010 to June 2019 were retrospectively analyzed.According to different treatment methods,they were divided into the observation group and control group.Fifty-eight patients in the control group were treated with cefoperazone and sulbactam,and 44 patients in the observation group were additionally treated with tigecycline,on the basis of the control group.The clinical curative effect,bacteriological curative effect,hospitalization time and mortality,changes of pulmonary function,blood gas indexes,inflammation indexes,nerve function and disease severity before and after the treatment were compared between the two groups.RESULTS The total effective rate of the treatment in the observation group(77.27%)was significantly higher than that in the control group(48.28%);bacterial clearance rate in the observation group(75.00%)was significantly higher than that in the control group(43.10%)(P<0.05).The hospitalization time and 28 d mortality in the observation group were significantly lower than that in the control group(P<0.05).After 7 days of treatment,the forced expiratory volume in one second%(FEV1%)and partial pressure of oxygen(PaO2)in the observation group were significantly higher than that in the control group,whereas partial pressure of carbon dioxide(PaCO2)was significantly lower than that in the control group(P<0.05).Levels of serum procalcitonin(PCT),white blood cell count(WBC),scores of National Institute Of Health Stroke Scale(NIHSS)and Acute Physiology and Chronic Health Evaluation(APACHEII)in the observation group were significantly lower than that in the control group(P<0.05).CONCLUSION Tigecycline can effectively improve curative effect of pulmonary infection in elderly patients with CI and PDR-AB,alleviate inflammation response,improve pulmonary function,promote nerve function recovery and disease rehabilitation.