本文關(guān)鍵詞： 呼吸機(jī)相關(guān)性肺炎 霧化吸入 阿米卡星　出處：《蚌埠醫(yī)學(xué)院》2013年碩士論文　論文類型：學(xué)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(dǎo)致的呼吸機(jī)相關(guān)性肺炎（VAP）的臨床療效。 方法以我院重癥加強(qiáng)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(yàn)進(jìn)行對比分析。根據(jù)納入和排除標(biāo)準(zhǔn)，將符合標(biāo)準(zhǔn)的56名VAP患者隨機(jī)分為實(shí)驗(yàn)組(29例)對照組(27例)。兩組均給予全身抗感染治療，實(shí)驗(yàn)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(xì)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(shí)驗(yàn)組與對照組比較，在治療療程、治療第1-5天CPIS無統(tǒng)計(jì)學(xué)意義（P＞0.05）；在治療第10-14天后，CPIS有統(tǒng)計(jì)學(xué)意義（P＜0.05）；治愈率分別為68.97%和40.74%，，有統(tǒng)計(jì)學(xué)意義（P＜0.05）；病原菌清除率分別為72.41%和55.56%，無統(tǒng)計(jì)學(xué)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(guān)性。實(shí)驗(yàn)組沒有因?yàn)殪F化吸入導(dǎo)致嚴(yán)重不良反應(yīng)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(yīng)。 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(xué)位授予單位】：蚌埠醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R563.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前4條

1 王兆東;鄧家華;周建平;金方;;呼吸道藥物遞送—霧化吸入劑的研究進(jìn)展[J];世界臨床藥物;2011年05期

2 柳梅;鄭萍;;靜脈注射聯(lián)合吸入抗生素治療呼吸機(jī)相關(guān)性肺炎97例[J];實(shí)用醫(yī)學(xué)雜志;2012年01期

3 於江泉;鄭瑞強(qiáng);林華;盧年芳;陳齊紅;邵俊;王海霞;殷靜靜;;多黏菌素E霧化吸入治療多藥耐藥革蘭陰性桿菌感染呼吸機(jī)相關(guān)性肺炎的臨床療效評價[J];中華醫(yī)院感染學(xué)雜志;2010年05期

4 楊慧寧;王鮮平;張娜;呂巖;高敏;楊玉蘭;呂曉麗;李愛玲;曹安鄉(xiāng);;呼吸機(jī)相關(guān)性肺炎的病原菌分布及耐藥性研究[J];中華醫(yī)院感染學(xué)雜志;2012年03期

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