临床肺部感染评分指导替加环素联合头孢哌酮钠舒巴坦钠治疗重症肺炎的价值

Value of Clinical Pulmonary Infection Score in guiding treatment of tigecycline combined with cefoperazone sodium and sulbactam sodium for severe pneumonia patients

目的探讨临床肺部感染评分(CPIS)指导替加环素联合头孢哌酮钠舒巴坦钠治疗重症肺炎的价值。方法选取重症肺炎患者60例,随机分为2组,每组30例。对照组根据经验应用抗菌药治疗,观察组在CPIS指导下应用抗菌药治疗,用药方案均为替加环素联合头孢哌酮钠舒巴坦钠。比较2组症状消失率、抗菌药应用时间、炎症指标[C反应蛋白(CRP)、降钙素原(PCT)、白细胞计数(WBC)]水平及不良反应。结果治疗2周时,2组患者发热症状均消失,2组肺啰音、咳痰的消失率比较,差异无统计学意义(P>0.05)。观察组抗菌药应用时间为(7.38±2.66) d,短于对照组的(9.82±2.89) d,差异有统计学意义(t=3.403,P=0.001)。2组患者治疗后的CRP、PCT、WBC水平均较治疗前降低,差异有统计学意义(P <0.05)。观察组不良反应发生率低于对照组,差异有统计学意义(P <0.05)。结论在CPIS的指导下采用替加环素联合头孢哌酮钠舒巴坦钠治疗重症肺炎安全、有效,可缩短用药时间,缓解患者症状。

Objective To investigate the value of Clinical Pulmonary Infection Score( CPIS) in guiding the treatment of tigecycline combined with cefoperazone sodium and sulbactam sodium for severe pneumonia patients. Methods Totally 60 patients with severe pneumonia were selected and randomly divided into two groups,with 30 cases in each group. Control group was treated with antibiotics according to the experience,and observation group was treated with antibiotics under the guidance of CPIS. The drug regimen in both groups was tigecycline combined with cefoperazone sodium and sulbactam sodium. The symptom disappearance rate,application time of antibiotics,levels of inflammatory indexes [C reactive protein( CRP), procalcitonin( PCT), white blood cell count( WBC) ]and adverse reactions were compared between the two groups. Results After 2 weeks of treatment,the fever symptoms disappeared in both groups,and there were no significant differences in the disappearance rate of pulmonary rales and expectoration between the two groups( P > 0. 05). The application time of antibiotics in the observation group was( 7. 38 ± 2. 66) days,which was significantly shorter than( 9. 82 ± 2. 89) days in the control group( t = 3. 403,P = 0. 001). The levels of CRP,PCT and WBC in both groups after treatment were significantly lower than those before treatment( P < 0. 05). The incidence of adverse reactions in the observation group was significantly lower than that in the control group( P < 0. 05). Conclusion Under the guidance of CPIS,tigecycline combined with cefoperazone sodium and sulbactam sodium is safe and effective in the treatment of severe pneumonia patients,which can shorten the medication time and relieve the symptoms of patients.