摘要
目的 评价经纤维支气管镜肺泡灌洗阿米卡星在呼吸机相关肺炎合并肾功能不全患者中的应用。方法选择我院2011年6月～2015年6月呼吸机相关肺炎合并肾功能不全的患者48例随机分为观察组和对照组,两组均使用头孢哌酮舒巴坦钠针抗感染治疗,对照组在气管镜肺泡灌洗后不保留药物,观察组在肺泡灌洗后下气道内保留硫酸阿米卡星针,治疗结束后比较观察组、对照组治疗前后及两组之间常用评价指标的变化。结果观察组治疗7 d后APACHEⅡ评分、CPIS评分、PCT、CRP与治疗前及对照组治疗7 d后比较,差异有统计学意义（P〈0.05）;观察组治疗14 d后与对照组治疗14 d后比较CPIS、PCT差异有统计学意义（P〈0.05）,但两组APACHEⅡ、CRP差异无统计学意义（P〉0.05）;观察组治疗前后GFR无恶化（P〉0.05）;观察组与对照组住院天数比较差异有统计学意义（P〈0.05）。结论 通过支气管镜肺泡灌洗给予阿米卡星局部保留,联合使用头孢哌酮舒巴坦治疗MDA-PA致VAP合并肾功能不全患者,与单用头孢哌酮舒巴坦比较,治疗后APACHEⅡ、CPIS、CRP、PCT均有明显好转,而血清肌酐没有明显升高,并且住院天数明显缩短,可减轻患者经济负担。
Objective To evaluate the application of amikacin alveolar wash via fiber bronchoscope in patients with ventilator-a＇ssociated pneumonia accompanied with renal insufficiency. Methods 48 patients with ventilator-associated pneumonia accompanied with renal insufficiency treated in our hospital from June 2011 to June 2015 were selected and randomly divided into observation group and control group. Patients in both groups were given cefoperazone sulbactam sodium injection for anti-infective therapy. After alveolar wash with bronchoseope, no medicine was retained in the control group, while amikacin sulfate injection was retained in lower airway in the observation group. After treatment, changes of common evaluation indexes before and after treatment in control group and observation group and between two groups were compared. Results The APACHE H scores, CPIS scores, PCT, and CRP of observation group at 7 days after treatment were significantly different from those before treatment and those in the control group at 7 days after treatment （P〈0.05）. There were significant differences in CPIS and PCT between two groups at 14 days after treatment （P〈0.05）, but there were no significant differences in APACHE H and CPIS（P〉0.05）. There was no progression of GFR in observation group （P〉0.05）. There was significant difference in hospital stay between two groups（P〈0.05）. Conclusion Alveolar wash with bronchoscope and local retaining of amikacin combined with cefoperazone sulbactam can evidently improve the APACHE H, CPIS, PCT, and CRP of patients with MDA induced VAP accompanied with renal insufficiency, and there is no significant increase of serum creatinine, with significantly shorter hospital stay and reduction of financial burden.
出处
《中国现代医生》
2016年第13期9-11,15,共4页
China Modern Doctor
关键词
支气管肺泡灌洗
阿米卡星
呼吸机相关肺炎合并肾功能不全
多重耐药铜绿假单胞菌
Bronchoalveolar wash
Amikacin
Ventilator-associated pneumonia accompanied with renal insufficiency
Multi-drug resistant pseudomonas aeruginosa
