摘要
目的探讨雾化吸入妥布霉素注射液治疗囊性纤维化(CF)患儿铜绿假单胞菌(Pa)感染的可行性。方法回顾性分析2017年9月至2021年3月深圳市儿童医院收治并使用妥布霉素注射液雾化吸入治疗Pa感染的3例CF患儿的临床资料,分析其安全性和有效性。每日气道廓清后,使用妥布霉素注射液160 mg/次,雾化吸入,2次/d,疗程1个月后复查痰培养,如Pa未转阴,加环丙沙星30 mg/(kg·d),分2次口服,治疗1个月。结果3例CF患儿中,男2例,女1例。开始治疗最小年龄1岁,气道廓清结合雾化妥布霉素注射液治疗后,呼吸道症状和胸部CT均有好转。2例治疗1个月后Pa未转阴,加口服环丙沙星治疗1个月。3例治疗3个月~1.5年复查痰培养,Pa均转为阴性。3例治疗后多次随访肝、肾功能均无异常;无听力异常表现;1例治疗后复查脑干听觉诱发电位正常。结论在我国药物可及性的现状下,使用妥布霉素注射液雾化吸入治疗CF患者的Pa感染可能是一种合理的替代,值得进一步探讨。
Objective To investigate the feasibility of nebulizing injectable Tobramycin for the treatment of Pseudomonas aeruginosa(Pa)in pediatric cystic fibrosis(CF)patients.Methods The clinical data of 3 CF children with Pa infection who were treated by nebulizing injectable Tobramycin in Shenzhen Children′s Hospital from September 2017 to March 2021 were retrospectively analyzed.The efficacy and safety were explored.The nebulized injectable Tobramycin(160 mg/dose)was given twice daily after airway clearance.After one-month treatment course,oral Ciprofloxacin would be given[30 mg/(kg·d)]to patients for another 1 month if Pa was still positive in repeat sputum cultures.Results There were 2 males and 1 female in 3 cases recruited.The youngest patient was 1-year-old when receiving Tobramycin treatment.After airway clearance and inhalation of injectable Tobramycin,all had improvements in respiratory symptoms and chest CT scan.Two cases took additional oral Ciprofloxacin as Pa was still positive after the 1-month treatment course of Tobramycin.Pa turned to negative in all 3 cases after treatment for 3 months to 1.5 years.Besides,after treatment all the 3 patients had normal liver and renal functions,and normal hearing in multiple follow ups.One patient had a normal brainstem auditory evoked potential in the reexamination.Conclusions Nebulizing injectable Tobramycin would be a reasonable alternative to inhaled Tobramycin solution for treating pediatric CF patients with Pa in view of the present condition in China's Mainland.However,it is still worth further study and discussion.
作者
陈杰华
李志川
卢志威
鲍燕敏
王文建
郑跃杰
Chen Jiehua;Li Zhichuan;Lu Zhiwei;Bao Yanmin;Wang Wenjian;Zheng Yuejie(Department of Respiratory,Shenzhen Children′s Hospital,Shenzhen 518038,China)
出处
《中华实用儿科临床杂志》
CAS
CSCD
北大核心
2022年第22期1709-1713,共5页
Chinese Journal of Applied Clinical Pediatrics
基金
深圳市医学重点学科建设经费(SZXK032)。
