头孢他啶联合阿米卡星治疗轻中度神经外科术后肺部感染的回顾性研究

Retrospective Study of Ceftazidime Combined with Amikacin in the Treatment of Mild to Moderate Pulmonary Infection after Neurosurgery

目的:探讨头孢他啶联合阿米卡星治疗轻中度神经外科术后肺部感染的有效性及安全性。方法:采用回顾性研究方法,收集头孢他啶联合阿米卡星治疗(联合组)与头孢他啶单药治疗(单药组)神经外科术后轻中度肺部感染患者的一般资料,比较两组临床疗效指标、治疗前后主要炎症指标(白细胞计数WBC、C反应蛋白CRP、降钙素原PCT)变化及其差值、微生物学有效性及安全性方面的差异。结果:联合组临床总有效率为87.30%,明显高于单药组的69.09%(P<0.05);两组患者入住ICU、呼吸机使用、死亡人数以及住院天数等比较,差异无统计学意义(P>0.05)。治疗后,联合组患者的血WBC和CRP、PCT水平均明显低于本组治疗前(P<0.05);且其血CRP水平明显低于单药组(P<0.05)。上述炎症指标治疗前后差值比较,联合组均显著大于单药组(P<0.05)。联合组总细菌清除率为78.18%,明显高于单药组(P<0.05)。两组药品不良反应发生率差异无统计学意义(P>0.05)。结论:头孢他啶联合阿米卡星对于神经外科术后轻中度肺部感染可能具有一定的有效性及安全性,但应开展进一步的大样本随机对照研究来证实。

Objective:To investigate the efficacy and safety of ceftazidime combined with amikacin for the patients with mild to moderate pulmonary infection after neurosurgery.Methods:A retrospective study was carried out to analyze the differences in general data,clinical efficacy,changes of main inflammatory indexes before and after treatment[white blood cell(WBC),C-reactive protein(CRP),procalcitonin(PCT)],microbiological efficacy and safety between the group of ceftazidime combined with amikacin(combination group)and the group of ceftazidime monotherapy(monotherapy group)in patients with mild to moderate pulmonary infection after neurosurgery.Results:The rate of efficacy in the combination group was 87.30%,which was significantly higher than that of monotherapy group(P<0.05).There were no significant differences in ICU admission,ventilator use,number of deaths and length of stay between the two groups(P>0.05).After treatment,the levels of WBC,CRP and PCT in the combination group were significantly lower than those before(P<0.05);there was also significant difference in the levels of CRP between the combination group and monotherapy group(P<0.05).The inflammatory indexes disparity before and after treatment were significantly higher in the combination group than those in the monotherapy group(P<0.05).The bacteriological clearance rate in the combination group was 78.18%,which was significantly higher than that in the monotherapy group(P<0.05).There were no significant differences in the incidence of adverse drug reactions between the two groups(P>0.05).Conclusion:Ceftazidime combined with amikacin is effective and safe in the treatment of mild to moderate pulmonary infection after neurosurgery,which needs larger sample,randomized and controlled studies to prove its efficacy and safety further.