抗结核药物在治疗耐药结核病患者中的不良反应观察及处理

Observation and Treatment of Adverse Reactions of Anti tuberculosis Drugs in the Treatment of Drug Resistant Tuberculosis Patients

目的探讨抗结核药物在治疗耐药结核病患者中的不良反应发生情况及处理情况。方法选取300例耐药肺结核患者,均为我院2017年2月至2022年2月所收治,全部患者均选择标准化治疗方案治疗;对病历资料进行回顾性分析,对药物不良反应发生情况进行观察、记录。结果全部300例耐药肺结核患者中,发生不良反应的共276例,药物不良反应发生率为92.00%(276/300)。不同性别、年龄段、治疗分类的患者,其不良反应发生率比较差异无统计学意义(χ^(2)=0.9259、0.0619、1.7415,P=0.3359、0.8036、0.1869)。全部300例耐药肺结核患者中,共发生455例次不良反应;发生频次最高的不良反应为肝脏毒性反应,其次为关节痛或肌肉痛;在不良反应发生后,276例次的不良反应经过对症处理维持原治疗;133例次的不良反应需要停用或者更换药物;29例次的不良反应需要调整剂量;17例次的不良反应导致治疗停止。不良反应的发生时间中位数为64 d;不良反应最早发生在治疗当天,最晚则发生在治疗第309天。结论在采用抗结核药物治疗耐药结核病患者时容易发生各种不良反应,大部分经过对症处理后能继续原方案治疗;临床中应加强监测工作,并及时处理,不应轻易停药或者停止治疗,以确保临床疗效。

Objective To explore the occurrence and treatment of adverse reactions of anti tuberculosis drugs in the treatment of drug-resistant tuberculosis patients.Methods A total of 300 patients with drug-resistant pulmonary tuberculosis were selected and treated in our hospital from February 2017 to February 2022.All patients were treated with standardized treatment scheme.The medical records were retrospectively analyzed,and the occurrence of adverse drug reactions was observed and recorded.Results In all 300 cases of drug-resistant pulmonary tuberculosis,276 cases had adverse reactions,and the incidence of adverse reactions was 92.00%(276/300).There was no significant difference in the incidence of adverse reactions among patients of different gender,age group and treatment classification(χ^(2)=0.9259,0.0619,1.7415,P=0.3359,0.8036,0.1869).In all 300 cases of drug-resistant pulmonary tuberculosis,455 adverse reactions occurred.The most frequent adverse reaction was hepatic toxicity,followed by joint pain or muscle pain.After the occurrence of adverse reactions,276 cases of adverse reactions maintained the original treatment after symptomatic treatment,133 times of adverse reactions required drug discontinuation or replacement.The dosage of 29 adverse reactions should be adjusted,17 times of adverse reactions caused the treatment to stop.The median time of adverse reaction was 64 days.The earliest adverse reaction occurred on the day of treatment,and the latest occurred on the 309th day of treatment.Conclusion In the treatment of drug-resistant tuberculosis patients with anti tuberculosis drugs,it is easy to have various adverse reactions,and most of them can continue the original treatment after symptomatic treatment.Clinical monitoring should be strengthened and timely treatment should be carried out.Drugs or treatment should not be stopped easily to ensure clinical efficacy.