摘要
目的评估经纤维支气管镜(纤支镜)阿米卡星肺泡灌洗治疗产超广谱β-内酰胺酶(ESBLs)肺炎克雷伯菌引起的呼吸机相关肺炎(VAP)的疗效和安全性。方法选取2016年2月至2017年2月该院重症监护病房(ICU)收治的产ESBLs肺炎克雷伯菌引起的VAP机械通气患者48例作为研究对象,采用随机数字表法分为观察组和对照组,每组24例。2组均使用哌拉西林/舒巴坦钠4.5 g(每6 h用药1次),并每天行支气管肺泡灌洗吸痰,观察组在每天支气管肺泡灌洗治疗结束后用阿米卡星0.4 g加10 mL生理盐水灌洗。记录2组患者治疗前后急性生理和慢性健康评分Ⅱ(APACHEⅡ)、临床肺部感染评分(CPIS)、降钙素原(PCT)等,比较治疗结束时的炎性反应变化、平均机械通气时间、ICU停留时间等。结果与治疗前比较,2组患者治疗后APACHEⅡ、CPIS、PCT均明显下降,且观察组患者治疗后APACHEⅡ、CPIS、PCT下降程度均大于对照组,差异均有统计学意义(P<0.05)。观察组患者治疗后支气管肺泡灌洗液培养产ESBLs肺炎克雷伯菌转阴率明显高于对照组,差异有统计学意义(P<0.05)。2组患者平均机械通气时间、ICU停留时间比较,差异均有统计学意义(P<0.05)。结论经纤支镜阿米卡星肺泡灌洗治疗产ESBLs肺炎克雷伯菌引起的VAP,对阿米卡星敏感的产ESBLs肺炎克雷伯菌效果较好,且能达到更高的细菌清除率,降低患者机械通气时间及ICU停留时间。
Objective To evaluate the efficacy and safety of amikacin alveolar lavage by fiberoptic bronchoscope intreating extendspectrum-beta-lactamase（ESBLs）-producing Klebsiella pneumoniae（KP）caused ventilator-associated pneumo-nia（VAP）. Methods Forty-eight mechanical ventilation patients with ESBLs-producing Klebsiella pneumoniae caused VAPin ICU of this hospital from February 2016 to February 2017 were selected and divided into the observation group and controlgroup by adopting the random number table method,24 cases in each group. Both groups used piperacillin/sulbactam sodium4.5 g（once every 6 h）,and conducted bronchoalveolar lavage for conducting sputum suction daily. The observation group usedamikacin 0.4 g adding 10 mL normal saline lavage after the end of daily bronchoalveolar lavage. The scores of the acute physiologyand chronic health evaluation Ⅱ（APACHEⅡ）,clinical pulmonary infection score（SPIS）,procalcitonin（PCT）and C reactiveprotein（CRP）before and after treatment were recorded in the two groups.The inflammatory response change,duration of me-chanical ventilation and ICU stay time were compared at the end of treatment. Results Compared with the before treatment,the APACHEⅡ score,CPIS and PCT after treatment in the two groups were significantly decreased（PP〈0.05）.The decreasingdegrees of APACHEⅡ score,CPIS and PCT after treatment in the observation group were greater than those in the controlgroup,the difference was statistically significant（P〈0.05）.The negative conversion rate of bronchoalveolar lavage fluid cultur-ing ESBLs producing KP after treatment in observation group was significantly higher than that in the control group,the differ-ence was statistically significant（P〈0.05）.The average mechanical ventilation time and ICU stay time had statistical differencebetween the two groups（P〈0.05）. Conclusion The amikacin alveolar lavage by fiberoptic bronchoscope for treating ESBLsproducing KP caused VAP has better effect,especially for the amikaci
作者
丘伟杰
池伟文
周向军
QIU Weijie;CHI Weiwen;ZHOU Xiangjun(Yuedong Hospital,Third Affiliated Hospital of Zhongshan University,Meizhou,Guangdong 514700,China)
出处
《现代医药卫生》
2018年第18期2835-2838,共4页
Journal of Modern Medicine & Health
