多黏菌素E治疗ICU患者肺部鲍曼不动杆菌感染的临床回顾性研究

A retrospective clinical study of polymyxin E in the treatment of pulmonary Acinetobacter baumannii infection in ICU patients

目的研究多黏菌素E治疗重症监护室(ICU)患者肺部鲍曼不动杆菌(AB)感染的临床疗效以及安全性,以期为临床诊疗提供理论依据参考。方法选取2021年1月至2022年2月树兰杭州医院ICU收治的119例AB肺炎患者入组,经过细菌学培养,采集患者气道分泌物确定AB阳性。入组患者根据用药分为实验组和对照组,实验组63例,经静脉、雾化,或者静脉联合雾化等方式使用多黏菌素E联合其他药物进行治疗,每日用药为150万~300万单位。对照组患者56例,使用其他抗生素(包括注射用舒巴坦钠、注射用头孢哌酮钠舒巴坦钠、替加环素、美罗培南或伏立康唑)进行治疗,给药剂量为标准剂量。两组抗生素给药时间均超过3 d。对所有患者治疗前后白细胞计数(WBC)、降钙素原(PCT)、C反应蛋白(CRP)水平,以及总胆红素、谷丙转氨酶(ALT)、谷草转氨酶(AST)、肌酐、肾小球滤过率等肝肾功能指标进行记录分析。观察治疗后不良反应情况。结果实验组63例患者中,46例患者病情好转,17例治疗无效(其中3例患者死亡),治疗有效率为73.0%;对照组56例患者中,26例患者病情好转,30例治疗无效(其中9例患者死亡),治疗有效率为46.4%,两组治疗有效率存在显著差异(P<0.05)。两组患者治疗后的WBC、PCT、CRP水平均较治疗前有明显下降,具有统计学意义(P<0.05),且实验组经过治疗后WBC、PCT、CRP水平均显著低于对照组(P<0.05)。与治疗前相比,两组患者ALT、AST、肌酐、肾小球滤过率治疗前后无显著变化,但总胆红素在治疗后有所下降(P<0.05),组间无差异。两组均无严重不良反应发生,不良反应发生率无显著差异(P>0.05)。结论多黏菌素E可用于ICU患者肺部多重耐药AB感染治疗,效果显著,安全可靠。

Objective To study the clinical efficacy and safety of polymyxin E in the treatment of pulmonary Acinetobacter baumannii(AB)infection in ICU patients,so as to provide a theoretical basis for clinical diagnosis and treatment.Methods A total of 119 patients with AB pneumonia admitted to ICU in Shulan Hangzhou Hospital from January 2021 to February 2022 were selected and enrolled.After bacteriological culture,airway secretions were collected from the patients to determine AB positive.The enrolled patients were divided into the experimental group and the control group according to the medication.In the experimental group,63 patients were treated with polymyxin E combined with other drugs by intravenous injection,nebulization,or intravenous injection combined with nebulization,with a daily dose of 1.53.0 million units.In the control group,56 patients were treated with other antibiotics(including sulbactam sodium for injection,cefoperazone sodium and sulbactam sodium for injection,tigecycline,meropenem or voriconazole)at standard doses.Antibiotics were administered for more than 3 d in both groups.The levels of white blood cell count(WBC),procalcitonin(PCT),C-reactive protein(CRP),as well as liver and kidney function indicators such as total bilirubin,alanine aminotransferase(ALT),aspartate aminotransferase(AST),creatinine,and glomerular filtration rate were recorded and analyzed before and after treatment.The adverse reactions after treatment were observed.Results Among the 63 patients in the experimental group,46 patients were improved and 17 patients failed to respond to treatment,among which 3 patients died,and the response rate of the treatment was 73.0%;among the 56 patients in the control group,26 patients improved and 30 patients failed to respond to treatment,among which 9 patients died,and the response rate was 46.4%,with a significant difference in response rate between the two groups(P<0.05).The levels of WBC,PCT and CRP in the two groups after treatment were significantly decreased compared with those before treatment,with statistical significance(P<0.05),but the levels of WBC,PCT and CRP in the experimental group were significantly lower than those in the control group after treatment(P<0.05).There were no significant changes in ALT,AST,creatinine,and glomerular filtration rate in the two groups before and after treatment,while total bilirubin decreased after treatment(P<0.05),and there was no difference between the two groups.No serious adverse reactions occurred in the two groups,and there was no significant difference in the incidence of adverse reactions(P>0.05).Conclusion Polymyxin E can be used to treat pulmonary multi-drug resistant AB infection in ICU patients,with significant effect,safety,and reliability.