CAJ | 학술논문

目的观察利奈唑胺经验治疗耐甲氧西林葡萄球菌(MRS)肺炎的临床效果及安全性.方法采用回顺性队列研究,收集山东省滨州市人民医院2009年3月-2010年10月使用利奈唑胺治疗MRS肺炎的住院患者135例,将患者分为经验治疗组(75例),即入院后立即应用利奈唑胺0.6 g,静脉滴注,1次/12 h;目标治疗组(60例),待细菌培养确定为MRS感染后再选用利奈唑胺治疗.观察治疗后的病情评分、临床疗效及不良反应,并重点评价高危肺炎患者的治疗效果.采用SPSS 13.0软件进行统计学分析.结果经验治疗组和目标治疗组治疗3 d和7 d后病情评分较治疗前均显著下降(t经验治疗=12.29和16.53,t目标治疗=9.36和11.49,P值均<0.05),且组间比较差异也有统计学意义(t=2.64和3.08,P值均<0.01).经验治疗组在肺炎吸收时间、ICU住院天数及总的住院天数方面与目标治疗组相比,差异具有统计学意义(t=6.61、4.39和10.25,P值均<0.05).两组临床有效率分别为88.0%(66/75)和83.3%(50/60)(x2=0.60,P>0.05).对于高危人群肺炎患者,治疗后两组临床有效率分别为86.8%(33/38)和63.6%(14/22),差异有统计学意义(X2=4.42,P<0.05).经验治疗组不良反应发生率为6.7%(5/75),目标治疗组为5.0%(3/60),差异无统计学意义(x2=0.17,P>0.05).结论利奈唑胺作为MRS所致肺炎的经验用药能较快缓解症状,临床有效率高,尤其针对高危人群肺炎患者,疗效确切,安全性较好.
목적 관찰리내서알경험치료내갑양서림포도구균(MRS)폐염적림상효과급안전성.방법 채용회순성대렬연구,수집산동성빈주시인민의원2009년3월-2010년10월사용리내서알치료MRS폐염적주원환자135례,장환자분위경험치료조(75례),즉입원후립즉응용리내서알0.6 g,정맥적주,1차/12 h;목표치료조(60례),대세균배양학정위MRS감염후재선용리내서알치료.관찰치료후적병정평분、림상료효급불량반응,병중점평개고위폐염환자적치료효과.채용SPSS 13.0연건진행통계학분석.결과 경험치료조화목표치료조치료3 d화7 d후병정평분교치료전균현저하강(t경험치료=12.29화16.53,t목표치료=9.36화11.49,P치균<0.05),차조간비교차이야유통계학의의(t=2.64화3.08,P치균<0.01).경험치료조재폐염흡수시간、ICU주원천수급총적주원천수방면여목표치료조상비,차이구유통계학의의(t=6.61、4.39화10.25,P치균<0.05).량조림상유효솔분별위88.0%(66/75)화83.3%(50/60)(x2=0.60,P>0.05).대우고위인군폐염환자,치료후량조림상유효솔분별위86.8%(33/38)화63.6%(14/22),차이유통계학의의(X2=4.42,P<0.05).경험치료조불량반응발생솔위6.7%(5/75),목표치료조위5.0%(3/60),차이무통계학의의(x2=0.17,P>0.05).결론 리내서알작위MRS소치폐염적경험용약능교쾌완해증상,림상유효솔고,우기침대고위인군폐염환자,료효학절,안전성교호.
Objective To evaluate the efficacy and safety of linezolid in empirical treatment of methicillin-resistant Staphylococcus (MRS) pneumonia. Methods One hundred and thirty-five hospitalized patients with MSR pneumonia receiving linezolid from April 2009 to October 2010 were enrolled in this retrospective cohort study, and all subjects were assigned to two groups: 75 cases with empirical treatment (linezolid 0. 6 g by infusion q12h at admission) , and 60 cases with objective treatment (linezolid after the sputum culture). The severity score, clinical effect and adverse effect were observed, and the therapeutic effects in patients with high risk factors were especially evaluated. SPSS13.0 software was used for statistical analysis. Results The scores were decreased significantly after finishing therapeutic causes for 3 and 7 days in both groups (tempirical =12.29 and 16.53, tobjective =9.36 and 11.49, P<0. 05). There were significant differences in severity scores after 3 and 7 days between empirical and objective treatment groups (t =2. 64 and 3. 08, P < 0. 01). There were significant differences in absorption time, length of ICU and total hospital stay between two groups (t =6. 61 , 4. 39 and 10. 25, P <0. 05). In empirical and objective group, the effective rates were 88.0% (66/75) and 83.3% (50/60) (x2 = 0.60, P > 0.05 ). In the patients with high risk factors, the effective rates of two groups were 86. 8% (33/38) and 63. 6% (14/22) , and the difference was significant (x2 =4.42, P<0.05). The rate of adverse effects were 6.7% (5/75) in empirical group and 5.0% (3/60) in objective group, and the difference was not significant (x2 =0. 17, P > 0. 05). Conclusion Linezolid can be used as empirical treatment for MRS pneumonia with rapid symptoms relieve and high efficacy, especially for patients with high risk.