多黏菌素B治疗多重耐药性革兰阴性菌引起的呼吸机相关性肺炎的效果分析

Effect analysis of polymyxin B in the treatment of ventilator-associated pneumonia caused by multi-drug resistant gram-negative bacteria

目的探讨多黏菌素B治疗多重耐药性(MDR)革兰阴性菌引起的呼吸机相关性肺炎(VAP)的临床效果。方法230例MDR革兰阴性菌引起的VAP患者,根据治疗方法不同分为观察组和对照组,各115例。对照组患者采取常规治疗,观察组患者在对照组基础上采用多黏菌素B治疗。比较两组临床疗效、细菌清除情况及治疗前后C反应蛋白(CRP)、降钙素原(PCT)和细胞因子[白细胞介素(IL)-6、IL-8和肿瘤坏死因子-α(TNF-α)]水平。结果观察组治疗总有效率86.96%高于对照组的72.17%,差异有统计学意义(P<0.05)。观察组细菌清除率53.91%高于对照组的31.30%,差异有统计学意义(P<0.05)。治疗14 d,两组血清CRP和PCT水平均低于治疗前,且观察组血清CRP(8.94±2.21)mg/L和PCT(3.28±0.56)ng/ml均低于对照组的(16.28±3.55)mg/L和(7.91±1.53)ng/ml,差异有统计学意义(P<0.05)。治疗14 d,两组血清IL-6、IL-8和TNF-α水平均低于治疗前,且观察组血清IL-6(14.93±3.10)pg/ml、IL-8(7.84±1.64)pg/ml和TNF-α(7.35±1.53)pg/ml均低于对照组的(23.19±4.56)pg/ml、(14.23±2.89)pg/ml和(16.82±2.96)pg/ml,差异有统计学意义(P<0.05)。结论采用多黏菌素B治疗MDR革兰阴性菌引起的VAP疗效良好,且可有效减轻炎症反应。

Objective To discuss the clinical effect of polymyxin B in the treatment of ventilatorassociated pneumonia(VAP)caused by multi-drug resistant(MDR)gram-negative bacteria.Methods A total of 230 patients with VAP caused by MDR gram-negative bacteria were divided into observation group and control group according to different treatment methods,with 115 cases in each group.Patients in the control group received conventional treatment,and patients in the observation group received polymyxin B treatment on the basis of the control group.Both groups were compared in terms of clinical efficacy,bacterial clearance,C-reactive protein(CRP),procalcitonin(PCT)and cytokines[interleukin(IL)-6,IL-8 and tumor necrosis factor-α(TNF-α)]before and after treatment.Results The total effective rate 86.96%of the observation group was higher than 72.17%of the control group,and the difference was statistically significant(P<0.05).The bacterial clearance rate 53.91%of the observation group was higher than 31.30%of the control group,and the difference was statistically significant(P<0.05).After 14 d of treatment,the serum CRP and PCT in both groups were lower than those before treatment in this group,and the serum CRP(8.94±2.21)mg/L and PCT(3.28±0.56)ng/ml in the observation group were lower than(16.28±3.55)mg/L and(7.91±1.53)ng/ml in the control group.All the differences were statistically significant(P<0.05).After 14 d of treatment,the serum IL-6,IL-8 and TNF-αin both groups were lower than those before treatment in this group,and the serum IL-6(14.93±3.10)pg/ml,IL-8(7.84±1.64)pg/ml and TNF-α(7.35±1.53)pg/ml in the observation group were lower than(23.19±4.56)pg/ml,(14.23±2.89)pg/ml and(16.82±2.96)pg/ml in the control group.All the differences were statistically significant(P<0.05).Conclusion Polymyxin B has good efficacy on the treatment of VAP caused by MDR gram-negative bacteria,and can effectively reduce the inflammatory reactions.