PICU脑性瘫痪重症肺炎婴幼儿亚胺培南降阶梯治疗疗效分析
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摘要
目的观察亚胺培南/西司他丁对儿童重症监护病房(PICU)脑性瘫痪婴幼儿重症肺炎降阶梯治疗的疗效。方法选取2010年1月-2014年9月PICU救治的70例脑性瘫痪重症肺炎患儿,将其随机分为治疗组39例、对照组31例;治疗组起始给予静脉滴注亚胺培南,对照组起始给予静脉滴注头孢他啶,两组72h后依药敏试验结果选用抗菌药物,比较两组患儿疗效及转归。结果治疗12h后,两组患儿呼吸频率、心率及血气分析值均改善,治疗组改善更为显著(P<0.05);治疗组咳嗽、肺部啰音消失时间和住院时间均少于对照组(P<0.05);治疗组总有效率87.18%,高于对照组的32.26%;治疗组有创机械通气率和病死率分别为5.13%、2.56%,低于对照组的25.81%、16.13%,两组比较差异均有统计学意义(P<0.05)。结论对PICU脑性瘫痪婴幼儿重症肺炎,起始应用亚胺培南的降阶梯疗法疗效显著,可降低有创机械通气率和病死率,并可减少抗菌药物的应用。
OBJECTIVE To observe the therapeutic effect of the de-escalation therapy with imipenem-cilastatin on cerebral palsy infants with severe pneumonia in pediatric intensive care unit(PICU).METHODS A total of 70 cerebral palsy infants with severe pneumonia who were treated in the PICU from Jan 2010 to Sep 2014 were enrolled in the study and randomly divided into the treatment group with 39 cases and the control group with 31 cases.The treatment group was treated with intravenous drip of imipenem from the start,and the control group was treated with intravenous drip of ceftazidime from the start.The antibiotics were used based on the results of the drug susceptibility testing after the treatment for 72 hours,and the therapeutic effects and prognosis were observed and compared between the two groups of infants.RESULTS After the treatment for 12 hours,the respiratory rate,heart rate,and the blood gas analysis value of both groups were improved,and they were improved more significantly in the treatment group than in the control group(P<0.05).The time of disappearance of cough and pulmonary rales and the length of hospital stay were significantly shorter in the treatment group than in the control group(P<0.05).The total effective rate of the treatment group was 87.18%,significantly higher than 32.26% of the control group;the rate of invasive mechanical ventilation of the treatment group was 5.13%,lower than 25.81%of the control group;the mortality rate of the treatment group was 2.56%,lower than 16.13% of the control group,and there was significant difference between the two groups(P<0.05).CONCLUSION The de-escalation therapy with start use of imipenem can achieve significant effect on treatment of the cerebral palsy infants with severe pneumonia in the PICU,reduce the rate of invasive mechanical ventilation and mortality rate,and reduce the utilization rate of antibiotics.
OBJECTIVE To observe the therapeutic effect of the de-escalation therapy with imipenem-cilastatin on cerebral palsy infants with severe pneumonia in pediatric intensive care unit(PICU).METHODS A total of 70 cerebral palsy infants with severe pneumonia who were treated in the PICU from Jan 2010 to Sep 2014 were enrolled in the study and randomly divided into the treatment group with 39 cases and the control group with 31 cases.The treatment group was treated with intravenous drip of imipenem from the start,and the control group was treated with intravenous drip of ceftazidime from the start.The antibiotics were used based on the results of the drug susceptibility testing after the treatment for 72 hours,and the therapeutic effects and prognosis were observed and compared between the two groups of infants.RESULTS After the treatment for 12 hours,the respiratory rate,heart rate,and the blood gas analysis value of both groups were improved,and they were improved more significantly in the treatment group than in the control group(P<0.05).The time of disappearance of cough and pulmonary rales and the length of hospital stay were significantly shorter in the treatment group than in the control group(P<0.05).The total effective rate of the treatment group was 87.18%,significantly higher than 32.26% of the control group;the rate of invasive mechanical ventilation of the treatment group was 5.13%,lower than 25.81%of the control group;the mortality rate of the treatment group was 2.56%,lower than 16.13% of the control group,and there was significant difference between the two groups(P<0.05).CONCLUSION The de-escalation therapy with start use of imipenem can achieve significant effect on treatment of the cerebral palsy infants with severe pneumonia in the PICU,reduce the rate of invasive mechanical ventilation and mortality rate,and reduce the utilization rate of antibiotics.
引文
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[5]Montealegre MC,Maya JJ,Correa A,et al.First identification of OXA-72carbapenemase from Acinetobacter pittii in colombin[J].Antimicrob Agents Chemother,2012,56(7):3996-3998.
[6]胡海赟,王春,乔蓉,等.儿童重症监护病房感染病原菌分布及细菌耐药分析[J].中国实用儿科杂志,2011,26(12):920-923.
[7]汪在华,姚文艳,蔡小芳.PICU多药耐药菌感染现状分析[J].中华医院感染学杂志,2013,23(13):3260-3261.
[2]中国康复医学会儿童康复专业委员会,中国残疾人康复协会小儿脑性瘫痪康复专业委员会.小儿脑性瘫痪的定义、分型和诊断条件[J].中华物理医学与康复杂志,2007,29(5):309.
[3]中华医学会儿科学分会呼吸学组,中华儿科杂志编辑委员会.儿童社区获得性肺炎管理指南(2013修订)(上)[J].中华儿科杂志,2013,51(10):745-752.
[4]Sandium enge A,Diaz E,Bodf M.The rapy of ventilator-associated pneumonia a patient-based approach based on the ten rules of"The Tarragona Strategy"[J].Intensive Care Med,2003,29(6):876-883.
[5]Montealegre MC,Maya JJ,Correa A,et al.First identification of OXA-72carbapenemase from Acinetobacter pittii in colombin[J].Antimicrob Agents Chemother,2012,56(7):3996-3998.
[6]胡海赟,王春,乔蓉,等.儿童重症监护病房感染病原菌分布及细菌耐药分析[J].中国实用儿科杂志,2011,26(12):920-923.
[7]汪在华,姚文艳,蔡小芳.PICU多药耐药菌感染现状分析[J].中华医院感染学杂志,2013,23(13):3260-3261.