李虎,唐建国.雾化吸入抗生素治疗铜绿假单胞菌引起的呼吸机相关性肺炎的临床疗效和安全性[J].内科急危重症杂志,2016,22(5):
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| 中文关键词: 呼吸机相关性肺炎，雾化疗法，机械通气，铜绿假单胞菌 |
| 英文关键词:Ventilator-associated pneumonia, Aerosol therapy, Mechanical ventilation Pseudomonas aeruginosa |
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| 中文摘要: |
| 目的 评价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疗效和安全性。方法 研究为前瞻性开放性随机对照非盲研究,选取2011年01月至2014年12月期间铜绿假单胞菌引起的VAP患者76例,随机化分为雾化治疗组(试验组,38例)和常规治疗组(对照组,38例),比较雾化治疗结束后两组患者临床治愈率、细菌学反应、病死率、机械通气时间、住ICU时间及不良反应。结果 雾化组患者7天临床治愈率显著高于对照组(76.3% 比52.6%, P=0.031),但两组患者死亡率无明显差异。雾化组患者细菌载量在治疗过程中迅速降低,对照组患者细菌载量在治疗前3天内有明显降低,但后期未见明显下降。两组患者的平均机械通气时间、平均住院时间、平均住重症监护病房时间及不良反应未见明显差异。结论 雾化吸入阿米卡星治疗铜绿假单胞菌引起的VAP有助于提高患者临床治愈率和细菌清除率,但对患者病死率、住ICU时间、机械通气时间无明显影响。 |
| 英文摘要: |
| Objective To evaluate the effectiveness and safety of nebulized amikacin for the treatment of ventilator-associated pneumonia (VAP) caused by Pseudomonas aeruginosa. Method An open-label randomized controlled no-blind trial was conducted. From January 2011 to December 2014, a total of 76 VAP patients caused by Pseudomonas aeruginosa were randomly divided into control group (38 cases) and nebulized group (38 cases). The rate of clinical cure, bacterial response, mortality, duration of mechanical ventilation, length of hospital stay and adverse events were compared. Results At the 7th day, the rate of clinical cure in nebulized group was significantly higher than in control group[76.3% versus(vs) 52.6%, P=0.031]. At the 28th day, the rate of clinical cure in nebulized group was still higher than in control group, but there was not significant difference(84.2% vs 68.4%, p=0.105). Patients in nebulized group had rapid reduction of bacterial growth. Bacterial growth in control group reduced rapidly in preceding 3 days, but didn`t decline obviously in the following days. There were no significant differences between compared groups regarding duration of mechanical ventilation, the length of ICU stay and hospital stay and adverse events. Conclusion Nebulized amikacin as adjunctive therapy for treatment of VAP caused by Pseudomonas aeruginosa could increase the rate of clinical cure and reduce bacterial growth, but did not decrease patients` mortality, length of hospital stay and duration of mechanical. |
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