高剂量替考拉宁治疗耐甲氧西林金黄色葡萄球菌肺部感染合并低蛋白血症患者的临床疗效

Clinical Study on High-Dose Teicoplanin in the Treatment of Methicillin-Resistant Staphylococcus Aureus Pulmonary Infection with Hypoproteinemia Patients

目的探讨高剂量替考拉宁治疗耐甲氧西林金黄色葡萄球菌(MRSA)肺部感染合并低蛋白血症患者的临床疗效和安全性。方法选取2018年6月至2019年6月台州市立医院收治的61例MRSA肺部感染合并低蛋白血症住院患者作为研究对象,随机分为对照组(31例)与试验组(30例)。对照组给予替考拉宁注射液负荷剂量6 mg/kg,每12小时1次(前3剂),维持剂量6 mg/kg q24 h治疗,试验组给予负荷剂量12 mg/kg,每12小时1次(前3剂),维持剂量12 mg/kg,每24小时1次治疗,比较两组患者替考拉宁血药谷浓度(Cmin)及达标率、临床疗效、疗效指标及药物不良反应发生情况。结果试验组患者替考拉宁血药Cmin水平及达标率、临床治愈率高于对照组(P<0.05);试验组治愈患者体温恢复时间、白细胞计数(WBC)恢复时间、C反应蛋白(CRP)恢复时间、住院时间优于对照组(P<0.05),咳嗽咳痰消失时间与对照组比较,差异无统计学意义(P>0.05);两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论对MRSA肺部感染合并低蛋白血症患者提高替考拉宁给药剂量临床疗效显著,能够提高血药浓度,加速临床症状缓解,且不增加不良反应发生。

Objective To explore the clinical efficacy and safety of high-dose teicoplanin in treatment of methicillin-resistant Staphylococcus aureus(MRSA) pulmonary infection with hypoproteinemia patients. Methods A total of 61 patients with MRSA pulmonary infection and hypoproteinemia admitted to Taizhou Municipal Hospital from June 2018 to June 2019 were selected as the research objects and were randomly divided into a control group(31 cases) and an experimental group(30 cases). The control group were treated with loading dose of teicoplanin injection 6 mg/kg q12 h(the first 3 doses) and maintenance dose of 6 mg/kg q24 h. The experimental group were treated with loading dose of teicoplanin injection 12 mg/kg q12 h(the first 3 doses) and maintenance dose of 12 mg/kg q24 h. The trough serum concentration of teicoplanin and its compliance rate, clinical efficacy, curative effect indexes and adverse drug reactions were observed and compared between the 2 groups of patients. Results The trough serum concentration of teicoplanin, its compliance rate, clinical effective rate of the experimental group were higher than the control group(P<0.05). The temperature recovery time, white blood cell(WBC) count recovery time, C-reactive protein recovery time and hospitalization time of the cured patients in the treatment group were better than those in the control group(P<0.05), while the disappearance time of cough and expectoration was not significantly different from that in the control group(P>0.05). There was no significant difference in the incidence rate of adverse drug reactions between the 2 groups of patients(P>0.05). Conclusion Increasing the dose of teicoplanin for patients with MRSA lung infection combined with hypoproteinemia has a significant clinical effect, which can increase the blood concentration, accelerate the relief of clinical symptoms, and does not increase the occurrence of adverse reactions.