摘要
目的:比较重症革兰阳性(G+)球菌感染病人经验性与非经验性使用万古霉素在治疗效果、血药浓度和预后之间是否有差异,分析影响病人死亡的临床相关因素。方法:根据有无确切病原学证据将病人治疗分组,无病原学证据,经验使用万古霉素设为E组;有确切病原学培养证据证实G+球菌感染使用万古霉素设为P组。比较2组谷血药浓度、7 d抗感染治愈率、28 d生存率、肾功能等预后和疗效。使用logistic多因素回归分析病人死亡的临床相关因素。结果:共纳入60例重症感染病人,其中E组39例,P组21例,2组之间年龄、体质量、生化指标、病情轻重、谷浓度等差异无统计学意义(P>0.05),但使用万古霉素72 h后的体温和28 d生存率差异有统计学意义(P<0.05)。logistic多因素回归分析相关临床因素发现万古霉素谷浓度尿素氮和培养证实球菌感染与病人死亡相关。结论:和非经验使用万古霉素相比,经验性用药会降低病人28 d生存率,并影响病人抗感染疗效,而2组在血药浓度上并无差异。临床病人的肾功能尿素氮和培养证实球菌感染与病人不良预后及死亡相关,故建议确诊G+球菌感染后再使用万古霉素,并且注意监测病人肾功能情况。
Objective:To compare the therapeutic effects,blood drug concentration and prognosis between empirical and non-empirical use of vancomycin in patients with severe Gram-positive(G+)cocci infection,and analyze the clinical related factors of affecting patient death.Methods:According to the exact etiological evidence,the patients without etiological evidence were treated with vancomycin,and set as the group E;the patients with etiological evidence were treated with vancomycin,and set as the group P.The valley concentration,cure rate of 7 d anti-infection,28 d survival rate,renal function and curative effects were compared between two groups.The clinical related factors of death in two groups were analyzed using multivariate logistic regression.Results:Among 60 patients with severe infection,39 cases in group E and 21 cases in group P were identified.There was no statistical significance in age,body mass,biochemical index,disease severity and valley concentration between two groups(P>0.05),but the differences of body temperature and 28 d survival rate between two groups after 72 h of tretament with vancomycin were statistically significant(P<0.05).The results of multivariate logistic regression analysis of related clinical factors showed that the cocci infection was associated with patient death confirmed by ancomycin valley concentration,urea nitrogen and culture.Conclusions:Compared with the non-experimental use of vancomycin,the empirical use of vancomycin can decrease the 28 d survival rate,and affect the patient′s anti-infection efficacy,while there is not difference in blood drug concentration between two groups.The clinical patient′s kidney function,urea nitrogen and culture confirm that the cocci infection is related to the poor prognosis and death of patients,so it is recommended that vancomycin be administered after the diagnosis of G+cocci infection,and that renal function should be monitored.
作者
邹琪
刘成
秦苏徽
路坤
顿士娟
余刚
赵士兵
汪华学
何先弟
ZOU Qi;LIU Cheng;QIN Su-hui;LU Kun;DUN Shi-juan;YU Gang;ZHAO Shi-bing;WANG Hua-xue;HE Xian-di(ICU,The First Afffiliated Hospital of Bengbu Medical College,Bengbu Anhui 233004,China)
出处
《蚌埠医学院学报》
CAS
2020年第3期319-322,共4页
Journal of Bengbu Medical College
基金
蚌埠医学院自然科学研究项目(BYKY1464)。
关键词
重症感染
革兰阳性球菌
经验性用药
万古霉素
谷浓度
ICU
severe infection
Gram-positive cocci
empirical medication
vancomycin
valley concentration
intensive care unit
