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目的探讨呼吸机相关性肺炎(VAP)抗生素治疗不同疗程对临床疗效及安全性的影响。方法将符合VAP诊断标准的机械通气患者145例随机分为二组,观察组103例,对照组42例,二组患者均给予初始经验性抗感染治疗,待病原学检测结果出来后及时调整给予敏感抗生素治疗,观察组抗生素治疗疗程<10d,对照组抗生素治疗疗程≥10d。治疗结束后比较二组临床疗效,并分析二组患者机械通气时间、脱机成功率、抗生素使用时间及ICU住院时间,并统计二组复发率。结果观察组抗生素使用时间为(8.6±1.4)d,对照组抗生素使用时间为(13.8±3.6)d,观察组明显短于对照组(P<0.05);二组临床疗效、机械通气时间、ICU住院时间、脱机成功率及病死率差异无统计学意义(P>0.05);观察组复发率高于对照组,但差异无统计学意义(P>0.05)。结论短程抗生素治疗VAP疗效与常规疗程相似,对于初始经验性抗感染治疗恰当、单一致病菌感染、无脓肿及免疫功能正常者,临床上推荐短疗程应用抗生素治疗。
Objective To investigate the effect of different courses of antibiotic therapy of ventilator-associated pneumonia (VAP) on the clinical efficacy and safety. Methods A total of 145 patients with mechanical ventilation meeting VAP diagnostic criteria were randomly divided into two groups: observation group (n = 103) and control group (n = 42). The two groups were given initial empirical anti-infective therapy. Sensitive antibiotic treatment, observation group antibiotic treatment course <10d, control group antibiotic treatment course ≥ 10d. After the treatment, the clinical efficacy of the two groups were compared. The mechanical ventilation time, the success rate of the off-line, the antibiotic use time and the ICU stay time were also analyzed. The relapse rates of the two groups were also calculated. Results The antibiotic use time in the observation group was (8.6 ± 1.4) days and that in the control group was (13.8 ± 3.6) days, which was significantly shorter in the observation group than in the control group (P <0.05). The clinical efficacy, duration of mechanical ventilation, There were no significant differences in hospitalization time, success rate of off-line and mortality (P> 0.05). The recurrence rate of the observation group was higher than that of the control group, but the difference was not statistically significant (P> 0.05). Conclusion Short-course antibiotic treatment of VAP is similar to the conventional course of treatment. For patients with initial empirical anti-infective therapy, single pathogen infection, abscess and normal immune function, short-course antibiotics are recommended clinically.