雾化吸入阿米卡星对治疗老年重症社区获得性肺炎的疗效观察
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摘要
目的通过雾化吸入阿米卡星治疗老年重症社区获得性肺炎(severe community-acquired pneumonia,SCAP),探讨治疗的有效性和安全性。方法将2015年1月至2016年12月郑州大学附属洛阳中心医院急诊重症监护病房(emergency intensive care unit,EICU)收治的老年SCAP患者106例分为雾化组和对照组各53例,两组年龄、性别、基础疾病、病原学构成及对阿米卡星的敏感性差异均无统计学意义(P>0.05)。对照组行常规治疗,雾化组在常规治疗基础上行阿米卡星雾化吸入,对两组机械通气时间、住重症监护病房(intensive care unit,ICU)天数、住院天数、抗生素使用时间,肺部感染评分(Clinical Pulmonary Infection Score,CPIS)、急性生理与慢性健康状况评分(Acute Physical and Chronic Health EvaluationⅡ,APACHEⅡ)评分、细菌清除率、治疗总有效率、28 d病死率及不良反应进行分析。结果雾化组机械通气时间、住ICU天数、住院天数、抗生素使用时间分别为(7.98±2.36)d、(9.81±1.90)d、(12.68±1.65)d、(11.21±1.40)d,短于对照组的(9.62±2.70)d、(12.34±2.72)d、(14.94±2.73)d、(13.77±2.25)d,差异有统计学意义(P<0.05);雾化组第7 d CPIS评分及APACHEⅡ评分较对照组及入院时明显减低,差异有统计学意义(P<0.05);雾化组细菌清除率及治疗总有效率分别为76%、81.13%,均高于对照组的56.52%、62.26%,差异有统计学意义(P<0.05);雾化组28 d病死率略低于对照组,不良反应发生率较低,两组28 d病死率与不良反应发生率差异无统计学意义(P>0.05)。结论雾化吸入阿米卡星治疗老年SCAP患者安全有效,值得推广。
Objective The efficacy and safety of the treatment were discussed by atomizing inhalation of Amikacin in the treatment of elderly patients with severe community-acquired pneumonia( SCAP). Methods From January 2015 to December 2016,106 cases of elderly patients with SCAP admitted to the department of emergency intensive care unit( EICU) in Luoyang Central Hospital affiliated to Zhengzhou University were randomly divided into the atomization group and the control group of 53 cases. There was no statistically significant difference between the two groups of age,gender,underlying disease,etiology and sensitivity to Amikacin( P > 0. 05). Control group was treated with conventional treatment,and atomization group was inhaled on the basis of conventional treatment. On two groups of mechanical ventilation time and ICU days,hospitalization days,antibiotic use time,Clinical Pulmonary Infection Score( CPIS) and acute Physical and Chronic Health Evaluation Ⅱ( APACHE Ⅱ),bacterial clearance rate and fatality rate,total effective rate of treatment,and28 days adverse reactions were analyzed. Results Mechanical ventilation time,ICU days,hospitalization days and antibiotic use time of Atomization group were( 7. 98 ± 2. 36) d,( 9. 81 ± 1. 90) d,( 12. 68 ± 1. 65) d,( 11. 21 ± 1. 40) d respectively. Control group was( 9. 62± 2. 70) d,( 12. 34 ± 2. 72) d,( 14. 94 ± 2. 73) d,( 13. 77 ± 2. 25) d. The data of the atomization group was shorter than that of control group. The difference was statistically significant( P < 0. 05). The 7 th day CPIS score and APACHE Ⅱ score of atomization group were significantly lower than that of control group and the admission,the difference was statistically significant( P < 0. 05). The total effective rate and bacterial clearance in the atomization group was 76% and 81. 13%,respectively,which was higher than 56. 52% and 62. 26%of the control group,and the difference was statistically significant( P < 0. 05). The mortality rate of 28 d in atomization group was slightly lower than that in control group,and the incidence of adverse reactions was low. There was no statistically significant difference betweenthe two groups' 28 d mortality and the incidence of adverse reactions( P > 0. 05). Conclusion It is safe and effective of aerosolized Amikacin in the treatment of SCAP in the elderly and worth popularizing.
Objective The efficacy and safety of the treatment were discussed by atomizing inhalation of Amikacin in the treatment of elderly patients with severe community-acquired pneumonia( SCAP). Methods From January 2015 to December 2016,106 cases of elderly patients with SCAP admitted to the department of emergency intensive care unit( EICU) in Luoyang Central Hospital affiliated to Zhengzhou University were randomly divided into the atomization group and the control group of 53 cases. There was no statistically significant difference between the two groups of age,gender,underlying disease,etiology and sensitivity to Amikacin( P > 0. 05). Control group was treated with conventional treatment,and atomization group was inhaled on the basis of conventional treatment. On two groups of mechanical ventilation time and ICU days,hospitalization days,antibiotic use time,Clinical Pulmonary Infection Score( CPIS) and acute Physical and Chronic Health Evaluation Ⅱ( APACHE Ⅱ),bacterial clearance rate and fatality rate,total effective rate of treatment,and28 days adverse reactions were analyzed. Results Mechanical ventilation time,ICU days,hospitalization days and antibiotic use time of Atomization group were( 7. 98 ± 2. 36) d,( 9. 81 ± 1. 90) d,( 12. 68 ± 1. 65) d,( 11. 21 ± 1. 40) d respectively. Control group was( 9. 62± 2. 70) d,( 12. 34 ± 2. 72) d,( 14. 94 ± 2. 73) d,( 13. 77 ± 2. 25) d. The data of the atomization group was shorter than that of control group. The difference was statistically significant( P < 0. 05). The 7 th day CPIS score and APACHE Ⅱ score of atomization group were significantly lower than that of control group and the admission,the difference was statistically significant( P < 0. 05). The total effective rate and bacterial clearance in the atomization group was 76% and 81. 13%,respectively,which was higher than 56. 52% and 62. 26%of the control group,and the difference was statistically significant( P < 0. 05). The mortality rate of 28 d in atomization group was slightly lower than that in control group,and the incidence of adverse reactions was low. There was no statistically significant difference betweenthe two groups' 28 d mortality and the incidence of adverse reactions( P > 0. 05). Conclusion It is safe and effective of aerosolized Amikacin in the treatment of SCAP in the elderly and worth popularizing.
引文
[1]中华医学会呼吸病学分会.中国成人社区获得性肺炎诊断和治疗指南(2016年版)[J].中华结核和呼吸杂志,2016,39(4):253-279.
[2]赵春江,张菲菲,王占伟,等.2012年中国成人社区获得性呼吸道感染主要致病菌耐药性的多中心研究[J].中华结核和呼吸杂志,2015,38(1):18-22.
[3]von Baum H,Welte T,Marre R,et al.Community-acquired pneumonia through enterobacteriaceae and pseudomonas aeruginosa:diagnosis,incidence and predictors[J].Eur Res J,2010,35(3):598-605.
[4]陈旭岩,于学忠,沈洪,等.北京地区三级甲等综合医院急诊科成人重症社区获得性肺炎诊治现况和致病原调查[J].中国急救医学,2013,33(6):511-515.
[5]彭松,张琳,周树生,等.社区和医院获得性肺炎致病菌体外耐药性分析[J].中华疾病控制杂志,2014,18(9):851-854.
[6]Salih W,Schembri S,Chalmers J D.Simplification of the IDSA/ATS criteria for severe CAP using meta-analysis and observational data[J].Eur Respir J,2014,43(3):842-851.
[7]韩立红,祝坤.PCT和CPIS对老年CAP预后的评估价值[J].临床肺科杂志,2014,19(4):673-675.
[8]童凯.雾化吸入阿米卡星治疗呼吸机相关性肺炎的临床疗效和安全性[J].临床肺科杂志,2016,21(10):1862-1864,1865.
[9]鲁炳怀,时琰丽,李雪清,等.血清降钙素原在诊断老年肺部感染中的临床价值[J].首都医科大学学报,2014,35(4):456-462.
[10]李虎,杨春辉,薛杨勇,等.雾化吸入阿米卡星治疗铜绿假单胞菌引起的呼吸机相关性肺炎的临床观察[J].内科急危重症杂志,2016,22(5):335-337.
[11]Menéndez R,Torres A,Rodriguez de Castro F,et al.Reaching stability in community-acquired oneumonia:the effects of the severity of disease,treatment,and the characteristics of patients[J].Clin Infect Dise,2004,39(12):1783-1790.
[12]赵文艳,陈颖,吕治,等.口腔干预措施预防老年医院获得性肺炎的临床研究[J].首都医科大学学报,2013,34(4):582-586.
[13]范颖楠,冯筑生,尹文.社区获得性肺炎临床研究进展[J].临床误诊误治,2015,28(6):101-104.
[14]Owens R C Jr,Ambrose P G.Antimicrobial stewardship and the role of pharmacokinetics-pharmacodynamics in the modern antibiotic era[J].Diagn Microbiol Infect Dis,2007,57(3 Suppl):77-83.
[15]马明远,徐杰,于娜,等.综合ICU内鲍曼不动杆菌的耐药性和相关因素分析[J].中华危重病急救医学,2013,25(11):686-689.
[16]单凯,贾东梅,郭伟.卒中相关性肺炎的诊断——卒中并发肺炎研究组专家共识[J].中华急诊医学杂志,2015,24(12):1346-1348.
[17]牟照红,张家丽,许辉.雾化吸入阿米卡星治疗多重耐药铜绿假单胞菌呼吸机相关肺炎效果观察[J].中国医药导报,2015,12(27):165-168.
[18]邱春华,邢颜平,刘翠,等.阿米卡星不同给药方式治疗呼吸机相关性肺炎疗效观察[J].人民军医,2014,57(5):517-518.
[19]李漪,侯俊,黄锐,等.A-DROP评分和CURB-65评分量表对重症社区获得性肺炎的诊断意义[J].中国煤炭工业医学杂志,2015,18(7):1146-1149.
[20]杨春辉,李虎,薛杨勇,等.雾化吸入阿米卡星气道分泌物及血药动力学特点[J].内科急危重症杂志,2013,19(3):165-167.
[21]中华医学会呼吸病学分会《雾化吸入疗法在呼吸疾病中的应用专家共识》制定专家组.雾化吸入疗法在呼吸疾病中的应用专家共识[J].中华医学杂志,2016,96(34):2696-2708.
[2]赵春江,张菲菲,王占伟,等.2012年中国成人社区获得性呼吸道感染主要致病菌耐药性的多中心研究[J].中华结核和呼吸杂志,2015,38(1):18-22.
[3]von Baum H,Welte T,Marre R,et al.Community-acquired pneumonia through enterobacteriaceae and pseudomonas aeruginosa:diagnosis,incidence and predictors[J].Eur Res J,2010,35(3):598-605.
[4]陈旭岩,于学忠,沈洪,等.北京地区三级甲等综合医院急诊科成人重症社区获得性肺炎诊治现况和致病原调查[J].中国急救医学,2013,33(6):511-515.
[5]彭松,张琳,周树生,等.社区和医院获得性肺炎致病菌体外耐药性分析[J].中华疾病控制杂志,2014,18(9):851-854.
[6]Salih W,Schembri S,Chalmers J D.Simplification of the IDSA/ATS criteria for severe CAP using meta-analysis and observational data[J].Eur Respir J,2014,43(3):842-851.
[7]韩立红,祝坤.PCT和CPIS对老年CAP预后的评估价值[J].临床肺科杂志,2014,19(4):673-675.
[8]童凯.雾化吸入阿米卡星治疗呼吸机相关性肺炎的临床疗效和安全性[J].临床肺科杂志,2016,21(10):1862-1864,1865.
[9]鲁炳怀,时琰丽,李雪清,等.血清降钙素原在诊断老年肺部感染中的临床价值[J].首都医科大学学报,2014,35(4):456-462.
[10]李虎,杨春辉,薛杨勇,等.雾化吸入阿米卡星治疗铜绿假单胞菌引起的呼吸机相关性肺炎的临床观察[J].内科急危重症杂志,2016,22(5):335-337.
[11]Menéndez R,Torres A,Rodriguez de Castro F,et al.Reaching stability in community-acquired oneumonia:the effects of the severity of disease,treatment,and the characteristics of patients[J].Clin Infect Dise,2004,39(12):1783-1790.
[12]赵文艳,陈颖,吕治,等.口腔干预措施预防老年医院获得性肺炎的临床研究[J].首都医科大学学报,2013,34(4):582-586.
[13]范颖楠,冯筑生,尹文.社区获得性肺炎临床研究进展[J].临床误诊误治,2015,28(6):101-104.
[14]Owens R C Jr,Ambrose P G.Antimicrobial stewardship and the role of pharmacokinetics-pharmacodynamics in the modern antibiotic era[J].Diagn Microbiol Infect Dis,2007,57(3 Suppl):77-83.
[15]马明远,徐杰,于娜,等.综合ICU内鲍曼不动杆菌的耐药性和相关因素分析[J].中华危重病急救医学,2013,25(11):686-689.
[16]单凯,贾东梅,郭伟.卒中相关性肺炎的诊断——卒中并发肺炎研究组专家共识[J].中华急诊医学杂志,2015,24(12):1346-1348.
[17]牟照红,张家丽,许辉.雾化吸入阿米卡星治疗多重耐药铜绿假单胞菌呼吸机相关肺炎效果观察[J].中国医药导报,2015,12(27):165-168.
[18]邱春华,邢颜平,刘翠,等.阿米卡星不同给药方式治疗呼吸机相关性肺炎疗效观察[J].人民军医,2014,57(5):517-518.
[19]李漪,侯俊,黄锐,等.A-DROP评分和CURB-65评分量表对重症社区获得性肺炎的诊断意义[J].中国煤炭工业医学杂志,2015,18(7):1146-1149.
[20]杨春辉,李虎,薛杨勇,等.雾化吸入阿米卡星气道分泌物及血药动力学特点[J].内科急危重症杂志,2013,19(3):165-167.
[21]中华医学会呼吸病学分会《雾化吸入疗法在呼吸疾病中的应用专家共识》制定专家组.雾化吸入疗法在呼吸疾病中的应用专家共识[J].中华医学杂志,2016,96(34):2696-2708.