本文選題：替加環(huán)素 + 多重耐藥��； 參考：《南昌大學(xué)》2017年碩士論文

【摘要】：目的:通過回顧性觀察替加環(huán)素治療多重耐藥菌肺部感染的臨床療效,為肺部多重耐藥菌感染的合理治療提供依據(jù)。方法:收集2013年1月-2016年7月期間在南昌大學(xué)第二附屬醫(yī)院住院,診斷肺部感染,兩次以上細(xì)菌培養(yǎng)提示多重耐藥革蘭氏陰性桿菌感染(排外銅綠假單胞菌),使用替加環(huán)素治療5天以上的患者資料,從臨床和病原學(xué)兩方面綜合分析其療效,并應(yīng)用SPSS 22.0軟件進(jìn)行統(tǒng)計學(xué)分析。結(jié)果:1.入選患者92例,其中男性患者73例,給藥時間平均為9.7±4.3天。2.患者用藥后體溫下降,用藥第3天、第5天、第7天的平均體溫分別與用藥第1天的平均體溫比較,P0.05,差異有統(tǒng)計學(xué)意義。WBC、N%、CRP、PCT四組感染指標(biāo)用藥后較用藥前明顯下降,P0.05,差異有統(tǒng)計學(xué)意義。分別以WBC=10×1 09/L、N%=70%、CRP=10mg/L、PCT=0.5ug/L作為截斷點,比較炎癥指標(biāo)在治療后轉(zhuǎn)為正常的比率,VAP組低于HAP組,但差異無統(tǒng)計學(xué)意義。以PCT=0.5ug/L作為截斷點評估降鈣素原在肺炎診斷中的敏感性,VAP組(81.7%)高于HAP組(57.9%),P0.05,差異有統(tǒng)計學(xué)意義。3.入組92例患者總體臨床有效率47.8%,各組臨床有效率:CAP患者組臨床有效率為100%,HAP(63.2%)VAP(42.3%)患者組,P=0.10,差異無統(tǒng)計學(xué)意義�！�75歲的高齡組(38.5%)低于75歲的非高齡組(51.5%),P=0.26,差異無統(tǒng)計學(xué)意義;APACHE Ⅱ評分≤15分組(54.2%)高于APACHE Ⅱ評分15分的患者組(28.0%),P0.05,差異有統(tǒng)計學(xué)意義;腎功能正常組(55.6%)高于腎功能損害(31.0%)的患者組,P0.05,差異有統(tǒng)計學(xué)意義;肝功能正常組、無低蛋白血癥組均高于肝功能損害、低蛋白血癥患者組,差異無統(tǒng)計學(xué)意義。4.使用替加環(huán)素前培養(yǎng)出耐藥菌257株,其中以多重耐藥鮑曼不動桿菌為主(56.8%),耐藥菌株大部分對替加環(huán)素敏感,總體病原菌清除率67.4%,多重耐藥鮑曼不動桿菌病原菌清除率58.7%。18.5%的患者在住院期間死亡。結(jié)論:1.替加環(huán)素對多重耐藥菌或泛耐藥菌所致的肺部感染有一定的療效,在沒有多粘菌素抗感染藥物可供選擇的情況下,以替加環(huán)素為主的聯(lián)合抗菌方案仍為較好的選擇。2.APACHE Ⅱ評分、腎功能損害影響替加環(huán)素的臨床療效。
[Abstract]:Objective: to observe the clinical effect of tigicycline in the treatment of multidrug resistant bacteria (MDR) pulmonary infection. Methods: from January 2013 to July 2016, the patients were hospitalized in the second affiliated Hospital of Nanchang University to diagnose pulmonary infection. Two or more times of bacterial culture suggested that multidrug resistant gram-negative bacilli (Pseudomonas aeruginosa, excluding Pseudomonas aeruginosa), which were treated with tegacycline for more than 5 days, were treated with tegicycline for more than 5 days. The clinical and etiological effects were analyzed comprehensively. SPSS 22.0 software was used for statistical analysis. The result is 1: 1. 92 patients were enrolled, 73 of them were male, the average administration time was 9.7 鹵4.3 days. The body temperature of the patients decreased after medication, the third day, the fifth day, The mean body temperature on the 7th day was significantly lower than that on the 1st day (P 0.05), and the difference was statistically significant. The ratio of inflammation to normal in VAP group was lower than that in HAP group, but there was no significant difference between VAP group and HAP group. The sensitivity of procalcitonin in the diagnosis of pneumonia in VAP group was 81.7% higher than that in HAP group (P 0.05). The difference was statistically significant. The overall clinical effective rate of 92 patients in the group was 47.8. The clinical effective rate of each group was 100 HAPN 63.22 and VAPP 42.3. There was no significant difference between the two groups (P = 0.10). The aged group 鈮，

本文編號：2000472