發(fā)布時間：2018-04-21 19:38

  本文選題：替加環(huán)素 + 醫(yī)院獲得性肺炎�。� 參考：《重慶醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的分析在醫(yī)院獲得性肺炎(hospital-acquired pneumonia,HAP)患者中運用替加環(huán)素(Tigecycline,TGC)治療的效果,為TGC的合理使用提供參考。方法回顧性分析我院2014年1月-2016年12月診斷為HAP的患者,并應(yīng)用TGC抗感染治療,評估其臨床療效和細(xì)菌學(xué)療效。運用SPSS.18進(jìn)行統(tǒng)計分析。結(jié)果24例患者符合入選標(biāo)準(zhǔn),平均年齡69.3±11.81歲,平均住院時間31.7±9.1天,TGC療程平均11.7±3.5天,患者APACHE II評分平均20.0±5.0分。在收集到的24例患者中,培養(yǎng)出鮑曼不動桿菌有23例,其中,對氟喹諾酮類環(huán)丙沙星、左氧氟沙星耐藥率分別為100%、91.30%,碳?xì)涿瓜╊悂啺放嗄�、美羅培南100%耐藥,氨基糖苷類阿米卡星100%耐藥,加酶抑制劑的氨芐西林/舒巴坦、哌拉西林/他唑巴坦、頭孢哌酮/舒巴坦耐藥率分別為100%、90.91%、82.61%、四環(huán)素類米諾環(huán)素、替加環(huán)素耐藥率分別為39.13%、0。24例患者的治療方案,均是以TGC為基礎(chǔ)的聯(lián)合。聯(lián)合使用最多的抗菌藥是碳?xì)涿瓜╊惡皖^孢哌酮舒巴坦,分別占22.5%、20%。24例患者,臨床有效率46.25%(n=11),細(xì)菌清除率25%(n=6),死亡率37.5%(n=9)。結(jié)論TGC可用于治療HAP,聯(lián)合應(yīng)用效果可能更佳。目的運用Meta分析方法評價替加環(huán)素(Tigecycline,TGC)治療醫(yī)院獲得性肺炎(hospital-acquired pneumonia,HAP)的臨床療效、細(xì)菌學(xué)療效及不良反應(yīng)。方法計算機(jī)檢索Pub Med、Medline、EBSCOhost、中國知網(wǎng)、維普、萬方等數(shù)據(jù)庫有關(guān)TGC治療HAP的對照研究,采用Rev Man5.0軟件進(jìn)行Meta分析。結(jié)果最終納入15篇文獻(xiàn),8篇RCT和7篇回顧性研究,合并分析提示TGC治療HAP時,臨床有效率優(yōu)于non-TGC組(OR=2.02,95%CI[1.36,3.00],P0.05),細(xì)菌清除率方面優(yōu)于non-TGC組(OR=1.68,95%CI[1.26,2.25],P0.05),總體死亡率方面優(yōu)于non-TGC組(OR=0.55,95%CI[0.37,0.83],P0.05)住ICU時間也優(yōu)于non-TGC組(SMD=-2.51,95%CI[-2.72,-2.29],P0.05),但不良反應(yīng)、總住院時間兩組比較沒統(tǒng)計學(xué)差異。亞組分析表明治療VAP時,其有效率、細(xì)菌清除率并不優(yōu)于non-TGC組;單藥治療HAP時,并不優(yōu)于non-TGC組。結(jié)論TGC可用于治療HAP,聯(lián)合應(yīng)用效果更佳,但仍需要更多高質(zhì)量的RCT來證實。
[Abstract]:Objective to analyze the therapeutic effect of tigecycline in hospital acquired pneumonia (HAP) patients, and to provide a reference for the rational use of TGC. Methods the patients with HAP diagnosed in our hospital from January 2014 to December 2016 were analyzed retrospectively. The clinical and bacteriological effects were evaluated by TGC antiinfective therapy. SPSS.18 was used for statistical analysis. Results the mean age was 69.3 鹵11.81 years old, the average hospitalization time was 31.7 鹵9.1 days and the average APACHE II score was 20.0 鹵5.0 days. Among the 24 patients, 23 were isolated from Acinetobacter baumannii. Among them, the resistance rates to fluoroquinolone ciprofloxacin and levofloxacin were 100%, 91.30%, 100%, 100%, respectively. Ampicillin / sulbactam, piperacillin / tazobactam and cefoperazone / sulbactam were 100% resistant to aminoglycoside amikacin, respectively. The drug resistance rates of tegacycline were 39.13 and 0.24 cases respectively, all of which were based on TGC. The most commonly used antimicrobial agents were hydrocarbon and cefoperazone sulbactam, accounting for 22.5% and 20.24 cases, respectively. The clinical effective rate was 46.25%. The bacterial clearance rate was 25% and the mortality rate was 37.5%. Conclusion TGC can be used in the treatment of HAP, and the combined application may be more effective. Objective to evaluate the clinical efficacy, bacteriological efficacy and adverse reactions of tigecycline (TGCs) in the treatment of hospital acquired pneumonia (HAP) by Meta analysis. Methods Pub Medline was searched by computer for the comparative study of TGC treatment HAP in the databases of Pub Medline Medline, China knowledge Network, Weip, Wanfang and so on. The Meta analysis was carried out with Rev Man5.0 software. Results the 15 literatures, including 8 RCT and 7 retrospective studies, were included in the study. The combined analysis suggested that TGC was used in the treatment of HAP. The subgroup analysis showed that the effective rate and bacterial clearance rate of VAP were not better than those of non-TGC group, and that of single drug treatment of HAP group was not better than that of non-TGC group. Conclusion TGC can be used in the treatment of HAP, but more high quality RCT is needed.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R563.1

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