抗生素降阶梯治疗重症肺炎的临床疗效及安全性

The clinical efficacy and safety of antibiotic de-escalation therapy in the treatment of severe pneumonia

目的判断重症肺炎患者使用抗生素降阶梯治疗的临床有效性。方法80例重症肺炎患者,采用随机数字表法将其分成研究组和对照组,各40例。研究组应用抗生素降阶梯疗法,对照组应用常规抗生素疗法。比较两组患者白细胞、降钙素原、C反应蛋白、氧合指数、重症加强护理病房(ICU)住院时间、治疗效果、并发症发生情况以及治疗1周后拔除气管插管成功率和停用血管活性药成功率。结果治疗后,研究组患者白细胞(8.65±2.07)×10^(9)/L、降钙素原(4.31±1.08)μg/L、C反应蛋白(36.49±6.15)mg/L均低于对照组的(10.37±2.11)×10^(9)/L、(7.23±2.15)μg/L、(60.73±7.83)mg/L,氧合指数(281.62±26.17)mm Hg(1 mm Hg=0.133 kPa)高于对照组的(191.93±18.74)mm Hg,ICU住院时间(11.25±3.62)d短于对照组的(16.18±4.13)d,差异均具有统计学意义(P<0.05)。研究组治疗总有效率97.50%高于对照组的65.00%,28 d死亡率0低于对照组的10.00%,并发症发生率10.00%低于对照组的35.00%,治疗1周后拔除气管插管成功率100.00%高于对照组的76.00%,治疗1周后停用血管活性药成功率95.00%高于对照组的70.00%,差异均具有统计学意义(P<0.05)。结论针对重症肺炎患者进行抗生素降阶梯治疗能够极大限度的降低患者的诊疗不适感,改善患者机体情况,促进患者早日康复,值得在临床诊疗中广泛使用。

Objective To judge the clinical efficiency of antibiotic de-escalation therapy on patients with severe pneumonia.Methods A total of 80 patients with severe pneumonia were divided into research group and control group according to random numerical table,with 40 cases in each group.The research group was treated with antibiotic de-escalation therapy,and the control group was treated with conventional antibiotic therapy.The white blood cells,procalcitonin,C-reactive protein,oxygenation index,duration of intensive care unit(ICU)stay,therapeutic effect,occurrence of complications,success rate of extubation and discontinuation of vasoactive drugs after 1 week of treatment were compared between the two groups.Results After treatment,the white blood cells(8.65±2.07)×10^(9)/L,procalcitonin(4.31±1.08)μg/L and C-reactive protein(36.49±6.15)mg/L of the research group were lower than(10.37±2.11)×10^(9)/L,(7.23±2.15)μg/L and(60.73±7.83)mg/L of the control group,oxygenation index(281.62±26.17)mm Hg(1 mm Hg=0.133 kPa)was higher than(191.93±18.74)mm Hg of the control group,and duration of ICU stay(11.25±3.62)d was shorter than(16.18±4.13)d of the control group.All the difference was statistically significant(P<0.05).The total effective rate 97.50%of the research group was higher than 65.00%of the control group,28-d mortality rate 0 was lower than 10.00%of the control group,incidence of complications 10.00%was lower than 35.00%of the control group,success rate of extubation of vasoactive drugs after 1 week of treatment 100.00%was higher than 76.00%of the control group,and success rate of discontinuation of vasoactive drugs 95.00%after 1 week of treatment was higher than 70.00%of the control group.All the difference was statistically significant(P<0.05).Conclusion For patients with severe pneumonia,antibiotic de-escalation therapy can greatly reduce the patient’s discomfort in diagnosis and treatment,improve the patient’s physical condition,thus promoting the early recovery of patients.It is worthy of being widely used in clinical diagnosis and treatment.