摘要
目的 探讨ICU严重腹腔感染患者病原学特点及替加环素联合头孢哌酮舒巴坦治疗的疗效.方法 选择安徽省肿瘤医院重症医学科2015年10月-2018年10月收治的严重腹腔感染患者65例作为研究对象,将其随机分为研究组35例(采用头孢哌酮钠舒巴坦钠+替加环素联合治疗)和对照组30例(采用头孢哌酮钠舒巴坦钠治疗),分析患者病原学分布特点,比较两组患者治疗效果、临床症状改善及治疗前后炎性因子C-反应蛋白(C reactive protein,CRP)、降钙素原(Procalcitonin,PCT)、白介素-6(Interleukin-6、IL-6)和急性生理与慢性健康状况评分Ⅱ(Acute physiology andchronic health evaluationⅡ,APACHEⅡ)、序贯器官衰竭评价评分(Sequential organfailure evaluation score,SOFA)、急性胃肠损伤评分(Acute GI injury,AGI)等指标.结果 65例患者病原菌培养共检出革兰阴性菌66例占88.00%,革兰阳性菌9例占12.00%,检出率较高的菌种有铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌;研究组治疗总有效率91.43%高于对照组的63.33%(x^ 2=7.545,P=0.006);与对照组相比,研究组退热时间、临床症状消失时间及住院时间均显著缩短(P<0.05);治疗后,两组患者炎症指标CRP、PCT、IL-6及疾病评分APACHEⅡ、SOFA、AGI均降低(P<0.05),且研究组上述指标均低于对照组(P<0.05).结论 ICU严重腹腔感染患者以革兰阴性菌感染为主,头孢哌酮钠舒巴坦钠联合替加环素对其具有良好的治疗效果,值得临床推广.
OBJECTIVE To explore the etiological characteristics of ICU patients with severe abdominal infection and observe the effect of cefoperazone sodium-sulbactam sodium combined with tigecycline on inflammatory factors.METHODS A total of 65 patients with severe abdominal infection who were treated in critical care medicine department of Anhui Cancer Hospital from Oct 2015 to Oct 2018 were recruited as the study objects and randomly divided into the the study group with 35 cases and the control group with 30 cases,the study group was treated with cefoperazone sodium-sulbactam sodium combined with tigecycline,while the control group was treated with cefoperazone sodium-sulbactam sodium.The etiological characteristics of the patients were analyzed,the curative effect,clinical symptoms,C-reactive protein(CRP),procalcitonin(PCT),interleukin-6(IL-6),acute physiology and chronic health evaluation II(APACHE II),sequential organ failure evaluation score(SOFA)and acute GI injury(AGI)were observed and compared between the two groups of patients.RESULTS Totally 66(88.00%)strains of gram-negative bacteria and 9(12.00%)strains of gram-positive bacteria were isolated from the 75 patients.The isolation rates of Pseudomonas aeruginosa,Escherichia coli and Klebsiella pneumoniae were high.The total effective rate of treatment of the study group was 91.43%,significantly higher than 63.33%of the control group(χ~2=7.545,P=0.006).The fever reduction time,time of disappearance of clinical symptoms and hospitalization time were significantly shorter in the study group than in the control group(P<0.05).The levels of inflammatory factors CRP,PCT and IL-6 and APACHE II,SOFA and AGI scores of the two groups of patients were significantly reduced after the treatment(P<0.05),and the above indexes of the study group were significantly lower than those of the control group(P<0.05).CONCLUSION The patients with gram-negative bacteria infections are dominant among the ICU patients with severe abdominal infections,and cefoperazone sodium-sulbactam sodium combined with tigecycline can achieve remarkable curative effect,and it is worthy to be promoted in the hospital.
作者
张湛
王晓兵
凌萌
王佩双
周婉
张琳琳
ZHANG Zhan;WANG Xiao-bing;LING Meng;WANG Pei-shuang;ZHOU Wan;ZHANG Lin-lin(West District of First Affiliated Hospital of China University of Science and Technology/Anhui Cancer Hospital,Hefei,Anhui 230031,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2020年第17期2666-2670,共5页
Chinese Journal of Nosocomiology
基金
国家自然科学基金资助项目(81800713)。
关键词
重症监护室
腹腔感染
头孢哌酮钠舒巴坦钠
替加环素
炎性因子
Intensive care unit
Abdominal infection
cefoperazone sodium-sulbactam sodium
Tigecycline
Inflammatory factor
