摘要
目的探讨ICU多重耐药铜绿假单胞菌感染肺炎的临床治疗对策,以及降钙素原对临床抗菌药物使用的指导意义。方法选取2012年1月至2017年12月温州医科大学附属第二医院ICU病房收治的经痰液样本分离出的铜绿假单胞菌感染肺炎患者142例,根据药敏试验结果分为非多重耐药菌种和多重耐药菌,每组71例,对两组患者分别使用抗菌药物进行治疗,对其临床效果进行探讨。同时,在治疗前及治疗后7 d、 14 d、21 d对71例ICU多重耐药铜绿假单胞菌感染肺炎患者降钙素原进行检测,对比使用一种抗菌药物和两种及以上抗菌药物在治疗前后的降钙素原,以及治疗后炎性指标的情况。结果非多重耐药菌种采用一种抗菌药物治疗的效果低于两种及以上抗菌药物治疗效果,两组相比差异无统计学意义(χ~2=0.137,P>0.05),多重耐药菌种采用一种抗菌药物治疗的效果低于两种及以上抗菌药物治疗效果,两组相比差异有统计学意义(χ~2=21.384,P<0.05);观察组与治疗组患者治疗前PCT检测结果差异无统计学意义(t=0.259,P>0.05);治疗后,两组PCT检测结果均有改善,观察组改善优于对照组,两组相比差异有统计学意义(t=4.572、6.839、11.287,P<0.05);治疗结束后,观察组CRP、白细胞计数、IL-6均低于对照组,两组差异有统计学意义(t=19.652、7.384、28.391,P<0.05)。结论 ICU铜绿假单胞菌感染肺炎患者应选用两种及以上抗菌药物进行治疗,PCT的检测对ICU多重耐药铜绿假单胞菌感染肺炎抗菌药物的使用起到指导性的作用。
Objective To explore the clinical treatment strategies of patients with multi-drug-resistant Pseudomonas aeruginosa pneumonia in ICU, and to discuss the clinical guidance of procalcitonin for the use of antibiotics. Methods A total of 142 patients with pneumonia caused by Pseudomonas aeruginosa isolated from the sputum samples in ICU from January 2012 to December 2017 were enrolled and divided into non-multi-drug resistant strain group(71 cases) and multi-drug-resistant bacteria group(71 cases) according to the results of drug susceptibility test.All subjects were treated with antibiotics and the therapeutic effects were discussed and compared.Meanwhile, procalcitonin was measured in 71 cases with multi-drug-resistant Pseudomonas aeruginosa pneumonia before treatment and 7 d, 14 d and 21 d after treatment with one or more antibiotics to compare the changes of procalcitonin. Results The therapeutic effect of one antibacterial drug to treat non-multi-drug-resistant Pseudomonas aeruginosa pneumonia was slightly lower than that of two or more antibacterial drugs with no significant difference(χ~2=0.137,P>0.05),while the effect was much lower for multi-drugresistant Pseudomonas aeruginosa pneumonia treatment with significant difference(χ~2=21.384,P<0.05).The PCT levels were similar between the two groups before treatment(t=0.259,P>0.05).However,after treatment,the PCT levels in both groups were improved,especially in patients with multi-drug-resistant Pseudomonas aeruginosa pneumonia(t=4.572,6.839,11.287,P<0.05).After the treatment,CRP,white blood cell count and IL-6 level in patients with multi-drug-resistant Pseudomonas aeruginosa pneumonia were significantly lower compared to those with non-multi-drug-resistant Pseudomonas aeruginosa pneumonia,the differences were statistically significant(t=19.652,7.384,28.391,P< 0.05). Conclusions Patients with Pseudomonas aeruginosa pneumonia should be treated with two or more antibacterial drugs.PCT detection may play aguiding role in the use of antibiotics for multi-drug-resistant Pseudomonas aeruginosa pneumonia treatment.
引文
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