外科重症脓毒症的抗菌药物降阶梯治疗研究

De-Escalation therapy of antimicrobial agents for severe surgical sepsis

目的 探讨外科重症脓毒症的抗菌药物治疗策略。方法 选择 2 0 0 2年 1月～ 2 0 0 3年 1月某院ICU收治的外科重症脓毒症患者 4 0例 ,其中 2 0例作为治疗组进行早期抗菌药物加强治疗 ,即采用抗菌药物降阶梯治疗策略 ;另外 2 0例作为对照组进行常规抗菌药物治疗。比较 2组病例的死亡率、呼吸机相关性肺炎 (VAP)发生率 ,并对 2组病例的平均ICU住院时间、平均呼吸支持时间、平均循环支持时间的差异进行分析。结果 治疗组的死亡率、VAP发生率明显低于对照组 ,而平均ICU住院时间、平均呼吸支持时间、平均循环支持时间也明显缩短。

Objective To evaluate the choice of antimicrobial agents for severe surgical sepsis. Methods Forty patients with severe surgical sepsis hospitalized in a hospital ICU from 2002, 1 to 2003, 1 were divided into treated group and control group. Twenty patients in the treated group received De Escalation therapy of antimicrobial agents, twenty patients in control group received routine therapy of antimicrobial agents. The mortality, the incidence of ventilation associated pneumonia (VAP), the average hospitalization period, the average respiratory supporting time and circulation time between two groups were compared and analysed. Results The treated group had lower mortality and lower incidence of VAP, and the average hospitalization time, average respiratory supporting time and circulation time were also shortened. Conclusion The De Escalation therapy of antimicrobial agents is an important and effective method for the treatment of severe surgical sepsis.