雾化阿米卡星在呼吸机相关性肺炎中的作用

The role of atomized amikacin in ventilator associated pneumonia

目的采用倾向匹配得分法(PSM)评估雾化吸入阿米卡星在革兰阴性菌引起的呼吸机相关性肺炎(VAP)中的治疗意义。方法回顾性分析上海市第五人民医院重症医学科2014年1月至2018年10月期间收治的呼吸机相关性肺炎共174例患者的资料。仅接受常规抗感染治疗的患者为对照组,共计114例。除接受常规抗感染治疗外,联合阿米卡星雾化吸入的患者作为雾化组,共计60例。使用倾向匹配得分法校正两组之间的不平衡基线参数。主要研究终点包括患者的28 d临床治愈率和28 d死亡率,次要研究终点包括患者的机械通气持续时间、住院时间和全身抗感染治疗天数。结果雾化组28 d临床治愈率高于对照组(78.2%vs.59.6%),差异有统计学意义(P=0.044),但两组患者28 d死亡率差异无统计学意义(14.9%vs.17.0%,P=0.778)。雾化组机械通气时间短于对照组[13(1016)vs.16(1220)],差异有统计学意义(P=0.045),抗生素治疗时间也短于对照组[12(1015)vs.15(1116)],差异有统计学意义(P=0.048)。多元回归分析显示,雾化阿米卡星、恰当的抗感染治疗有利于患者28 d的临床治愈率;而高体温,高急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)、合并脓毒症是影响患者28 d死亡率的独立因素。结论雾化吸入阿米卡星作为治疗革兰氏阴性菌引起的VAP的辅助治疗有助于提高患者28 d的临床治愈率,缩短机械通气时间和抗生素治疗天数,但未明显降低患者的死亡率。

Objective To evaluate the efficacy and safety of nebulized antibiotics in treating ventilator-associated pneumonia(VAP)due to Gram-negative bacteria using propensity score matching method(PSM).Methods A retrospective study were performed in ICU of the Fifth People Hospital of Shanghai from January 2014 to October 2018.A total of 174 patients with VAP were included in the study.Of which,114 patients only received systemic antibiotics treatment were included in control group;60 patients who received systemic antibiotics and nebulized amikacin were included in nebulized group.Unbalanced baseline parameters between two groups were corrected using PSM.Primary endpoints were patients.28-day clinical cure rate and 28-day mortality,the secondary endpoints included patients.duration of mechanical ventilation,length of hospital-stay and days of systemic antibiotics treatment.Results 28-day clinical cure rate in nebulized group was significantly higher than that in control group(78.2%vs.59.6%,P=0.044).No significant difference regarding 28-day mortality was observed between two groups(14.9%vs.17.0%,P=0.778).The duration of mechanical ventilation in nebulized group were significantly shorter than that in control group[13(10-16)vs.16(12-20),P=0.045].The duration of antibiotics treatment in nebulized group were significantly shorter than that in control group[12(10-15)vs.15(11-16),P=0.048].Multivariate analysis showed that nebulized amikacin and appropriate systemic antimicrobial treatment was in favour of patients.28-day clinical cure rate.Higher temperature,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score and combined with sepsis were independent factors affecting patients.28-day mortality.Conclusion Nebulizing amikacin as adjunctive therapy in treating VAP due to Gram-negative bacteria seemed to increase patients.28-day clinical cure rate and decrease the duration of mechanical ventilation and antibiotics treatment,but did not reduce patients.mortality.