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[目的]为1例耐多药结核病人循证制定治疗方案和该方案治疗效果分析。[方法]检索Cochrane图书馆(2007年第2期)、MEDLINE光盘数据库(1966～2007.7)、EMbase数据库(1984～2007.7)、维普中文科技期刊数据库(1989～2007年7月)、万方数据库(1997～2007.7)、中国学术期刊全文数据库(1994～2007.7),手工检索《中华结核和呼吸杂志》、《中国防痨杂志》杂志,筛选截至2007年7月的关于耐多药结核控制规范的文献和指南,评定文献质量,并进行综合分析。[结果]共纳入7篇文献,其中3篇为临床指南,1篇为Meta分析,3篇RCT。上述文献显示,对于已使用过一线药和二线药的耐多药结核患者,推荐使用个体化策略进行治疗。至少使用4种以上可能有效的抗结核药物组成化疗方案,按药物效力决定选用顺序。依据患者的细菌学变化情况、不良反应的监测情况、方案组成药物的抗菌效力等因素决定强化期疗程,整个疗程为痰分枝杆菌培养阴转后至少18个月。手术疗法是有效的辅助治疗方式。根据患者病情,制定出相应化疗方案,强化期6月,总疗程22月,患者获临床治愈。[结论]循证治疗耐多药结核可有效提高疗效。
[Objective] To develop an evidence-based treatment program for MDR-TB patients and analysis of the therapeutic effect of this regimen. [Methods] The Cochrane Library (No. 2 of 2007), MEDLINE (1966 ~ 2007.7), EMbase (1984 ~ 2007.7), VIP Chinese Science and Technology Periodical Database (1989 ~ 2007) 1997 ~ 2007.7), Chinese Academic Journal Full-text Database (1994 ~ 2007.7), Manuscripts of Chinese Journal of Tuberculosis and Respiratory Diseases, Chinese Journal of Prevention and Treatment of Diseases by hand, and selection of literature on control of MDR-TB as of July 2007 And guidelines, assess the quality of the literature, and conduct a comprehensive analysis. [Results] A total of 7 articles were included, of which 3 were clinical guidelines, 1 was Meta analysis and 3 RCTs. The above literature shows that for first-line and second-line MDR-TB patients, individualized strategies are recommended for treatment. At least 4 kinds of chemotherapy drugs that may be effective anti-TB drugs are used, and the order of selection is determined by the drug efficacy. According to the patient’s bacteriological changes, the monitoring of adverse reactions, the antibacterial efficacy of the drug composition of the program and other factors to determine the intensive course of treatment, the entire course of the sputum culture of Mycobacterium phlei after at least 18 months. Surgical treatment is an effective adjuvant treatment. According to the patient’s condition, formulate the corresponding chemotherapy regimen, intensive period of June, the total duration of treatment in 22 months, patients were clinically cured. [Conclusion] Evidence-based treatment of MDR-TB can effectively improve the curative effect.