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目的比较替加环素联合治疗对泛耐药鲍曼不动杆菌感染(PDRAB)的疗效差异,了解联合治疗的临床疗效和安全性。方法收集2011年1月至2014年12月广州市胸科医院重症监护病房(ICU)36例肺部泛耐药鲍曼不动杆菌的感染病例,根据替加环素联合使用情况分为对照组(替加环素,n=12)和观察A组(替加环素+亚胺培南,n=12)、观察B组(替加环素+头孢哌酮舒巴坦,n=12)。分别记录急性生理与慢性健康评分,一般生命体征、基础疾病、用药前后各种临床参数(血常规、肝肾功能、呼吸道症状、体征、影像学改变)及不良反应发生的情况,比较和分析替加环素联合治疗的临床疗效差异。结果观察组A和B的治愈率分别为25.0%、58.3%,高于对照组的16.7%;观察组A和B的有效率分别为41.7%、83.3%,高于对照组的33.3%;观察组A和B的细菌清除率分别为58.3%、83.4%,高于对照组的25.0%,差异有统计学意义(P<0.05)。观察组A和B病死率分别为25.0%,22.2%,低于对照组的33.3%,差异无统计学意义(P>0.05)。药物的主要不良反应表现为胃肠道反应,发生率均为25.0%。结论替加环素联合治疗对PDRAB的临床疗效均优于单一使用替加环素,主要的不良反应为恶心、呕吐和腹泻。
Objective To compare the efficacy of tigecycline with pan-drug resistant Acinetobacter baumannii infection (PDRAB) and to investigate the clinical efficacy and safety of combination therapy. Methods Thirty-six cases of pan-drug-resistant Acinetobacter baumannii infection from Guangzhou ICU were collected from January 2011 to December 2014. According to the combined use of tigecycline and control group Group B (tigecycline + cefoperazone sulbactam, n = 12) was observed in group A (tigecycline, n = 12) . Acute physical and chronic health scores, general vital signs, basic diseases, clinical parameters (blood, liver and kidney function, respiratory symptoms, signs, and imaging changes) and adverse reactions before and after treatment were recorded and compared. Clinical efficacy of cyclosporine combination therapy. Results The cure rates of observation group A and B were 25.0% and 58.3%, respectively, higher than that of the control group (16.7%). The effective rates of observation group A and B were 41.7% and 83.3%, respectively, which were higher than those of the control group The bacterial clearance rates of group A and group B were 58.3% and 83.4%, respectively, which were higher than those of control group (25.0%, P <0.05). The mortality of observation group A and B were 25.0% and 22.2%, respectively, which was lower than 33.3% of the control group, with no significant difference (P> 0.05). The main adverse drug reactions manifested gastrointestinal reactions, the incidence was 25.0%. Conclusion The combination therapy of tigecycline and PDRAB is better than single use of tigecycline. The main adverse reactions are nausea, vomiting and diarrhea.