本文選題：替加環(huán)素　切入點：超說明書用藥　出處：《浙江大學》2017年碩士論文　論文類型：學位論文

【摘要】：研究目的:由于多重耐藥菌和泛耐藥菌的出現(xiàn),臨床醫(yī)生開始應用替加環(huán)素。本文探討了替加環(huán)素在危重患兒術后多重耐藥菌感染中應用的療效及安全性。研究方法:回顧性分析2012年3月至2016年5月浙江大學醫(yī)學院附屬兒童醫(yī)院外科重癥監(jiān)護室(SICU)收住的外科術后嚴多重耐藥菌感染應用替加環(huán)素22例患兒的臨床數(shù)據(jù)。研究結果:(1)22例患兒(年齡45天-11歲)均為外科術后病人,其中先天性心臟病心內直視術后18例,大面積Ⅲ度燒傷2例,腸切除吻合術后1例,顱腦外科術后1例。入 ICU 的 SOFA 評分為 5.7±3.8,PRISMⅢ評分 10.6± 6.3。(2)22例患兒均為超說明書用藥,最常見是呼吸機相關性肺炎12例(54.5%)。(3)應用替加環(huán)素的情況:經驗用藥2例,目標治療20例。(4)應用替加環(huán)素前細菌學培養(yǎng)陽性20例,2例病人培養(yǎng)結果陰性;共分離出48株耐藥菌,最常見為鮑曼不動桿菌37株。(5)所有患兒應用替加環(huán)素的負荷量1.5mg/kg,維持量1-1.2mg/kg Q12H,療程為4天-22天。(6)臨床有效率86.4%,死亡4例,僅1例死于感染未控制;所有患兒未觀察到替加環(huán)素相關的不良反應。結論:替加環(huán)素治療外科術后病情危重和多重耐藥菌感染的患兒是臨床有效,并具有良好的安全性和耐受性。
[Abstract]:Objective: due to the emergence of multidrug resistant bacteria and pan-resistant bacteria, The efficacy and safety of tigicycline in the treatment of multidrug resistant bacterial infections in critically ill children after operation were investigated. Methods: from March 2012 to May 2016, Zhejiang University, Zhejiang Province, was retrospectively analyzed. Clinical data of 22 children with severe multidrug resistant bacterial infection after surgery received by the Surgical intensive Care Unit (ICU) of affiliated Children's Hospital, Medical College. There were 18 cases of congenital heart disease after open heart surgery, 2 cases of large area third degree burn, 1 case of intestinal resection and anastomosis and 1 case of craniocerebral surgery. The SOFA score of ICU was 5. 7 鹵3. 8 and 10. 6 鹵6. 3. 2%. The most common cases were 12 cases of ventilator-associated pneumonia (n = 12) with tegacycline: 2 cases were treated by experience, 20 cases were treated with target, 20 cases were positive by bacteriological culture before tegacyclin, and 2 cases were negative in culture, 48 strains of drug-resistant bacteria were isolated. The most common was Acinetobacter baumannii (37 strains). All the children were treated with tegicycline at a dose of 1.5 mg / kg and a maintenance dose of 1-1.2 mg / kg Q12H. The course of treatment was 4 days to 22 days. 6) the clinical effective rate was 86.4%, 4 cases died, only 1 case died of uncontrolled infection. Conclusion: tigicycline is effective and safe in the treatment of severe and multidrug resistant bacterial infections after surgery.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R726.5
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本文編號：1587527