本文關鍵詞： 呼吸機相關性肺炎 霧化吸入 阿米卡星　出處：《蚌埠醫(yī)學院》2013年碩士論文　論文類型：學位論文

【摘要】：目的評價霧化吸入阿米卡星治療多重耐藥（MDR）革蘭陰性菌感染導致的呼吸機相關性肺炎（VAP）的臨床療效。 方法以我院重癥加強治療病房（ICU）VAP患者為研究對象，將2011年11月-2013年02月收集的109例VAP患者的下呼吸道痰培養(yǎng)結(jié)果和藥敏試驗進行對比分析。根據(jù)納入和排除標準，將符合標準的56名VAP患者隨機分為實驗組(29例)對照組(27例)。兩組均給予全身抗感染治療，實驗組同時給予阿米卡星霧化吸入治療。比較兩組臨床肺部感染評分（CPIS）、治愈率和病原菌清除率，同時觀察患者耐受情況、肝腎功能和細菌耐藥等情況。 結(jié)果1、在109例VAP患者中下呼吸道共培養(yǎng)出127株不同的病原菌，革蘭氏陰性菌、革蘭氏陽性菌、真菌分別占病原菌總數(shù)的77.95%、13.39%、8.66%。排在前三位的分別是銅綠假單胞菌（16.54%）、鮑曼不動桿菌（11.81%）、肺炎克雷伯菌（8.66%）。藥敏分析顯示絕大多數(shù)革蘭氏陰性菌為MDR菌。 2、實驗組與對照組比較，在治療療程、治療第1-5天CPIS無統(tǒng)計學意義（P＞0.05）；在治療第10-14天后，CPIS有統(tǒng)計學意義（P＜0.05）；治愈率分別為68.97%和40.74%，，有統(tǒng)計學意義（P＜0.05）；病原菌清除率分別為72.41%和55.56%，無統(tǒng)計學意義（P＞0.05）。CPIS與患者的治愈率、病原菌清除率顯示出明顯的相關性。實驗組沒有因為霧化吸入導致嚴重不良反應發(fā)生。 結(jié)論1、霧化吸入阿米卡星能夠降低VAP患者的CPIS及提高治愈率，而無明顯不良反應。 2、霧化吸入阿米卡星在VAP患者的病原菌清除率上具有一定優(yōu)勢。
[Abstract]:Objective to evaluate the efficacy of atomization inhalation of amikacin in the treatment of ventilator associated pneumonia (VAP) caused by multidrug resistant MDR gram-negative bacteria infection. Methods the results of lower respiratory tract sputum culture and drug sensitivity test in 109 VAP patients collected from November 2011 to February 2013 were compared and analyzed according to the criteria of inclusion and exclusion. 56 patients with VAP were randomly divided into experimental group (n = 29), control group (n = 27) and control group (n = 27). The experimental group was treated with amikacin atomization inhalation at the same time. The clinical pulmonary infection score (CPIS), cure rate and pathogen clearance rate were compared between the two groups, and the patient's tolerance, liver and kidney function and bacterial drug resistance were observed at the same time. Results 1. In 109 patients with VAP, 127 strains of different pathogens were cultured in the lower respiratory tract, including Gram-negative bacteria, Gram-positive bacteria, and Gram-positive bacteria. Fungi accounted for 13.398.66. the first three were Pseudomonas aeruginosa 16.54g, Acinetobacter baumannii 11.81, Klebsiella pneumoniae 8.660.Drug sensitivity analysis showed that most gram-negative bacteria were MDR. 2.Compared with the control group, the treatment course of the experimental group, There was no significant difference (P > 0.05) in CPIS between 1-5 days and 10-14 days after treatment, the cure rates were 68.97% and 40.74, respectively (P < 0.05), and the pathogen clearance rates were 72.41% and 55.56, respectively (P > 0.05). There was no serious adverse reaction caused by atomization inhalation in the experimental group. Conclusion 1. Atomization inhalation of amikacin can reduce CPIS and improve cure rate of VAP patients without obvious adverse reaction. 2. Aerosol inhalation of amikacin has some advantages in the clearance rate of pathogens in patients with VAP.
【學位授予單位】：蚌埠醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R563.1

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