米诺环素与替加环素治疗重症肺炎患者临床观察

Clinical observation of minocycline and tigecycline on serum inflammatory factor levels in patients with severe pneumonia

目的既往呼吸机相关性重症肺炎患者的治疗获益不佳,多为单药治疗。本研究探讨米诺环素与替加环素对多重耐药鲍曼不动杆菌所致呼吸机相关性重症肺炎患者的临床应用价值,以指导临床对该类疾病的有效治疗。方法选取2018-02-01-2019-04-01在本院就诊的70例多重耐药鲍曼不动杆菌所致呼吸机相关性重症肺炎患者作为研究对象,按照性别、年龄和急性生理与慢性健康评分表组间匹配的原则分为对照组和观察组,各35例。对照组患者使用头孢哌酮舒巴坦钠联合米诺环素进行治疗,观察组患者使用头孢哌酮舒巴坦钠联合替加环素进行治疗,对比分析两组患者治疗前后血清炎症因子水平及免疫功能的变化情况。结果治疗后,观察组患者降钙素原(procalcitonin,PCT)水平为(2.10±0.21)ng/L,低于对照组的(3.40±0.37)ng/L,t=18.078,P<0.001;超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)水平为(14.26±3.27)mg/L,低于对照组的(17.92±4.39)mg/L,t=3.956,P<0.001;C反应蛋白(C-reactive protein,CRP)水平为(6.94±3.27)mg/L,低于对照组的(10.42±4.61)mg/L,t=3.643,P<0.001。观察组免疫球蛋白M(immunoglobulin M,IgM)水平为(1.28±0.37)g/L,高于对照组的(1.03±0.31)g/L,t=2.813,P=0.006;IgG水平为(12.23±1.59)g/L,高于对照组的(10.66±1.64)g/L,t=3.064,P=0.003;IgA水平为(2.10±0.20)g/L,低于对照组的(2.30±0.37)g/L,t=4.066,P<0.001。结论与米诺环素相较而言,对多重耐药鲍曼不动杆菌所致呼吸机相关性重症肺炎患者使用头孢哌酮舒巴坦钠联合替加环素进行治疗,能够有效改善患者免疫功能,减少炎症反应的发生。

OBJECTIVE The treatment of patients with severe ventilator-associated severe pneumonia has not received good results.This study explored the clinical application value of minocycline and tigecycline to patients with ventilator-associated severe pneumonia caused by multi-resistant Acinetobacter baumannii to guide the clinical effective treatment of this type of disease.METHODS A total of 70 patients with ventilator-associated severe pneumonia caused by multi-drug resistant Acinetobacter baumannii who were treated in our hospital from February 1 to April 1,2019 were selected as the research objects.According to the matching principle of gender,age and APACHEⅡ,patients were divided into control group and observation group,35 cases in each group.The patients in the control group were treated with cefoperazone sulbactam sodium combined with minocycline,and patients in the observation group were treated with cefoperazone sulbactam sodium combined with tigecycline.Changes in serum inflammatory factor levels and immune function before and after treatment of patients in the two groups were compared.RESULTS After treatment,the procalcitonin(PCT)level of the observation group was(2.10±0.21)ng/L,which was lower than that of the control group(3.40±0.37)ng/L,t=18.078,P<0.001.The level of hypersensitive C-reactive protein(hs-CRP)was(14.26±3.27)mg/L,lower than that of the control group(17.92±4.39)mg/L,t=3.956,P<0.001.The level of C-reactive protein(CRP)was(6.94±3.27)mg/L,which was lower than that of the control group(10.42±4.61)mg/L,t=3.643,P<0.001.The level of immunoglobulin M(IgM)in the observation group was(1.28±0.37)g/L,which was higher than that in the control group(1.030.31)g/L,t=2.813,P=0.006.The IgG level was(12.23±1.59)g/L,higher than the control group(10.66±1.64)g/L,t=3.064,P=0.003.IgA level was(2.10±0.20)g/L,lower than the control group(2.30±0.37)g/L,t=4.066,P<0.001.CONCLUSION Compared with minocycline,cefoperazone sulbactam sodium combined with tigecycline in patients with ventilator-associated severe pneumonia caused by multi-resistant Acinetobacter baumannii can effectively improve patients immune function and reduce the occurrence of inflammatory response.