多黏菌素E联合阿米卡星对多重耐药革兰阴性菌感染所致肺炎患者的影响

Analysis of the Effect of Polymyxin E Combined with Amikacin in the Treatment of Pneumonia Caused by Multidrug-Resistant Gram-Negative Bacterial Infection

目的研究多重耐药革兰阴性菌感染所致肺炎患者经多黏菌素E联合阿米卡星治疗的效果。方法选取2020年12月至2022年12月郑州市金水区总医院收治的多重耐药革兰阴性菌感染所致肺炎患者,选取其中49例采用多黏菌素E+阿米卡星治疗的设为研究组,依据配对原则1∶1选取采用阿米卡星治疗的设为参照组,两组共98例。比较两组治疗有效率、用力肺活量(FVC)、第1秒钟用力呼气容积与用力肺活量的比值(FEV_(1)/FVC)、呼气峰值流速(PEF)、第1 m最大呼气容积(FEV_(1))、临床症状改善时间、降钙素原(PCT)、C反应蛋白(CRP)、白细胞计数(WBC)、不良反应发生率。结果研究组治疗有效率(83.67%)高于参照组(65.31%),差异有统计学意义(P<0.05);研究组体温、肺部啰音、咳嗽、咳痰症状恢复正常时间均短于参照组,差异均有统计学意义(P<0.05);治疗后研究组FVC、FEV_(1)、PEF、FEV_(1)/FVC水平分别为(3.12±0.44)L、(2.41±0.31)L、(5.63±0.42)L/s、(77.24±3.85),高于参照组的(2.87±0.35)L、(2.02±0.36)L、(4.28±0.51)L/s、(70.38±4.06),差异均有统计学意义(P<0.05);治疗后研究组血清CRP、WBC、PCT水平[(7.43±1.98)mg/L、(7.62±1.38)×10^(9)/L、(2.63±0.45)ng/mL],低于参照组[(12.55±3.49)mg/L、(10.17±2.03)×10^(9)/L、(5.15±0.64)ng/mL],差异均有统计学意义(P<0.05);两组不良反应发生率相比,差异无统计学意义(P>0.05)。结论多黏菌素E联合阿米卡星治疗多重耐药革兰阴性菌感染肺炎者疗效显著,可改善肺功能,降低炎性因子水平,促进临床症状缓解,安全性较高。

Objective To study the effect of polymyxin E combined with amikacin in the treatment of pneumonia caused by multidrug-resistant gram-negative bacterial infection.Methods Patients with pneumonia caused by multidrug-resistant gram-negative bacterial infection admitted to the General Hospital of Jinshui District Zhengzhou City from December 2020 to December 2022 were selected.Among them,49 patients treated with polymyxin E+amikacin were set as the research group,and those treated with amikacin were set as the reference group according to the 1:1 pairing principle,with a total of 98 cases in both groups.The treatment effectiveness,forced vital capacity(FVC),the ratio of the volume of air that can be forcibly exhaled in the first second to the forced vital capacity(FEV_(1)/FVC),peak expiratory flow rate(PEF),maximum exhaled volume in the first meter(FEV_(1)),clinical symptom improvement time,procalcitonin(PCT),C-reactive protein(CRP),white blood cell count(WBC),and adverse reaction rate were compared between the two groups.Results The treatment effectiveness rate(83.67%)of the research group was higher than that of the reference group(65.31%),and the difference was statistically significant(P<0.05);the recovery time of body temperature,lung rales,cough,and sputum symptoms in the research group was shorter than that in the reference group,and the differences were statistically significant(P<0.05);after treatment,the levels of FVC,FEV_(1),PEF,and FEV_(1)/FVC in the research group were(3.12±0.44)L,(2.41±0.31)L,(5.63±0.42)L/s,and(77.24±3.85),respectively,which were higher than those in the reference group(2.87±0.35)L,(2.02±0.36)L,(4.28±0.51)L/s,and(70.38±4.06),and the differences were statistically significant(P<0.05);after treatment,the levels of serum CRP,WBC,and PCT in the research group[(7.43±1.98)mg/L,(7.62±1.38)×10^(9)/L,(2.63±0.45)ng/mL]were lower than those in the reference group[(12.55±3.49)mg/L,(10.17±2.03)×10^(9)/L,(5.15±0.64)ng/mL],and the differences were statistically significant(P<0.05);there was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion The treatment of pneumonia caused by multidrug-resistant gram-negative bacterial infection with polymyxin E combined with amikacin is significantly effective,can improve lung function,reduce the level of inflammatory factors,promote the relief of clinical symptoms,and has high safety.