摘要
目的 探究心脏病术后发生耐碳青霉烯类革兰阴性菌(CRGNB)感染肺炎患者使用多黏菌素B治疗的临床效果。方法 回顾性选取2018年9月至2021年8月于上海交通大学医学院附属瑞金医院接受治疗的96例心脏病术后CRGNB感染肺炎患者,给予患者不同剂量的多黏菌素B进行治疗,根据剂量的不同将其分为高剂量组(n=52)和低剂量组(n=44),两组患者首次负荷剂量均为2.5 mg/kg,高剂量组维持剂量为每次1.5 mg/kg, 2次/d,低剂量组每次1 mg/kg, 2次/d。两组均连续治疗14 d。观察比较两组患者临床疗效、菌清除率、住院相关指标及治疗期间不良反应发生情况。结果 高剂量组治疗有效率、细菌清除率为73.08%、63.46%,均高于低剂量组(47.73%、40.91%),差异均有统计学意义(P<0.05)。高剂量组机械通气时间和总住院时间为(92.46±18.39) h、(27.36±5.17) d,均低于低剂量组[(132.15±26.42) h、(37.68±7.33) d],差异均有统计学意义(P<0.05),但两组患者ICU住院时间之间差异无统计学意义(P>0.05)。两组均未出现神经毒性反应病例,两组中均出现2例患者在治疗过程中血肌酐水平异常上升,6例皮肤色素沉着,低剂量组中有4例患者出现皮肤色素沉着。两组患者不良反应之间差异无统计学意义(P>0.05)。结论 高剂量的多黏菌素B应用于心脏病术后CRGNB感染肺炎患者,能够在保证安全性的同时提升治疗效果和细菌清除率,减少机械通气时间和总住院时间。
Objective To explore the clinical efficacy of polymyxin B in patients with carbapenem-resistant Gram-negative bacteria(CRGNB)-infected pneumonia after cardiac surgery. Methods Ninety-six patients with CRGNB-infected pneumonia after cardiac surgery in Ruijin Hospital affiliated to Shanghai Jiao Tong University Medical College from September 2018 to August 2021 were retrospectively enrolled, and patients were classified into two groups according to polymyxin B dosage. After the initial loading dose of 2.5 mg/kg, the high-dose group(n=52) was initiated on a maintenance dose of 15 mg/kg/dose every day, and the low-dose group(n=44) was initiated on a maintenance dose of 1 mg/kg/dose every day. Both groups were treated continuously for 14 days. Then comparison was conducted on the clinical efficacy, bacterial clearance rate, hospital-related indicators and adverse reactions during treatment. Results The clinical efficacy rate and bacterial clearance rate were 73.08% and 63.46% in high-dose group, which were higher than those in low-dose group(47.73%, 40.91%), the differences were statistically significant(P<0.05). Duration of mechanical ventilation and total hospitalization in high-dose group were(92.46±18.39) h,(27.36±5.17) days, which were shortened than those in the low-dose group[(132.15±26.42) h,(37.68±7.33) d], the differences were statistically significant(P<0.05), while no statistical difference was found in ICU stay length(P>0.05). No cases of neurotoxic effects occurred in either group, and two patients in each group experienced an abnormal rise in blood creatinine levels during treatment. Six patients in high-dose group had skin pigmentation during treatment, while 4 patients in the low-dose group developed skin pigmentation. There was no significant difference in adverse reactions between the two groups(P>0.05). Conclusion Application of high-dose polymyxin B in patients with CRGNB-infected pneumonia after cardiac surgery can improve the therapeutic effect and bacterial clearance rate while ensuring saf
作者
郁骐襄
刘晓颖
陈俊佶
秦凯捷
朱云鹏
顾坚未
YU Qi-xiang;LIU Xiao-ying;CHEN Jun-ji(Department of Cardiac Intensive Care,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China.)
出处
《临床和实验医学杂志》
2022年第24期2610-2613,共4页
Journal of Clinical and Experimental Medicine
基金
上海申康医院发展中心临床科技创新项目(编号:SHDC12018X11)。
关键词
多黏菌素B
耐碳青霉烯类革兰阴性菌
心脏病
肺炎
细菌清除率
Polymyxin B
Carbapenem-resistant Gram-negative bacteria
Heart disease
Pneumonia
Bacterial clearance
