CAJ | 학술논문

目的：评估经纤维支气管镜阿米卡星肺泡灌洗治疗多重耐药治疗鲍曼不动杆菌（multidrug-resistant acinetobacter baumanii，MDR-Ab）呼吸机相关肺炎（ventilator-associated pneumonia，VAP）的效果和安全性。方法将42例多重耐药鲍曼不动杆菌呼吸机相关性肺炎的机械通气患者随机分为观察组和对照组，每组21例。两组均使用头孢哌酮舒巴坦钠3.0 g，1次/6小时并每日行支气管肺泡灌洗吸痰，观察组每日支气管肺泡灌洗治疗结束后用阿米卡星0.4 g加10 mL生理盐水灌洗，对照组使用阿米卡星7.5 mg/kg静脉滴注1次/天。记录治疗前后急性生理与慢性健康评分Ⅱ（acute physiology and chronic health evaluation Ⅱ，APACHE Ⅱ）、临床肺部感染评分（clinical pulmonary infection score，CPIS)、血清肌酐（Cr）、C-反应蛋白（CRP），比较两组治疗结束时支气管肺泡灌洗液细菌学检查转阴率、28 d病死率。结果与治疗前相比，两组APACHEⅡ评分、CPIS、CRP治疗后均有下降（P<0.05）。观察组患者治疗结束后其APACHEⅡ评分、CPIS、CRP下降均较对照组显著（P<0.05）。与治疗前比观察组Cr水平未见明显变化（P＞0.05），而对照组Cr水平有显著升高（P<0.05）。治疗结束时，支气管肺泡灌洗液培养MDR-Ab转阴率观察组显著高于对照组[80.9%（17/21）vs 42.8%（9/21），P<0.05]，随访28 d病死率两组未见差异[23.8%（5/21）vs 33.3%（7/21）（P＞0.05）]。结论与静脉给药相比，经纤维支气管镜阿米卡星肺泡灌洗治疗多重耐药鲍曼不动杆菌呼吸机相关性肺炎效果较好且能达到更高的细菌清除率，同时有效减轻肾脏毒性。
목적：평고경섬유지기관경아미잡성폐포관세치료다중내약치료포만불동간균（multidrug-resistant acinetobacter baumanii，MDR-Ab）호흡궤상관폐염（ventilator-associated pneumonia，VAP）적효과화안전성。방법장42례다중내약포만불동간균호흡궤상관성폐염적궤계통기환자수궤분위관찰조화대조조，매조21례。량조균사용두포고동서파탄납3.0 g，1차/6소시병매일행지기관폐포관세흡담，관찰조매일지기관폐포관세치료결속후용아미잡성0.4 g가10 mL생리염수관세，대조조사용아미잡성7.5 mg/kg정맥적주1차/천。기록치료전후급성생리여만성건강평분Ⅱ（acute physiology and chronic health evaluation Ⅱ，APACHE Ⅱ）、림상폐부감염평분（clinical pulmonary infection score，CPIS)、혈청기항（Cr）、C-반응단백（CRP），비교량조치료결속시지기관폐포관세액세균학검사전음솔、28 d병사솔。결과여치료전상비，량조APACHEⅡ평분、CPIS、CRP치료후균유하강（P<0.05）。관찰조환자치료결속후기APACHEⅡ평분、CPIS、CRP하강균교대조조현저（P<0.05）。여치료전비관찰조Cr수평미견명현변화（P＞0.05），이대조조Cr수평유현저승고（P<0.05）。치료결속시，지기관폐포관세액배양MDR-Ab전음솔관찰조현저고우대조조[80.9%（17/21）vs 42.8%（9/21），P<0.05]，수방28 d병사솔량조미견차이[23.8%（5/21）vs 33.3%（7/21）（P＞0.05）]。결론여정맥급약상비，경섬유지기관경아미잡성폐포관세치료다중내약포만불동간균호흡궤상관성폐염효과교호차능체도경고적세균청제솔，동시유효감경신장독성。
Objective To evaluate the efficacy and safety of amikacin by fiberoptic bronchoscopy lavage treatment of multidrug-resistant acinetobacter baumannii (multidrug-resistant acinetobacter baumanii, MDR-Ab) ventilator-associated pneumonia (ventilator-associated pneumonia, VAP). Methods The 42 patients in mechanical ventilation with multidrug-resistant Acinetobacter baumannii ventilator-associated pneumonia were randomly divided into observation group and control group, each group of 21 cases. Both groups use cefoperazone sulbactam 3.0 g intravenous infusion (every 6 hours) and bronchoalveolar lavage suction daily, after the end of the daily bronchoalveolar lavage observation group continue with amikacin 0.4 g in 10 mL of normal saline lavage, control group using amikacin 7.5 mg/kg intravenous infusion (every day). Record acute physiology and chronic health evaluationⅡ(APACHEⅡ), the clinical pulmonary infection score (CPIS), serum creatinine (Cr), C-reactive protein (CRP) before and after treatment, also bronchial lavage lfuid bacteriological examination negative rate, 28-day mortality were compared at the end of treatment. Results Compared with the previous treatment, APACHEⅡscore, CPIS, CRP were decreased in both groups(P<0.05). Compared with control group, APACHEⅡscore, CPIS, CRP in observation group decreased signiifcantly after treatment (P<0.05). Cr levels did not change in observation group after treatment (P>0.05), while the control group has signiifcantly higher levels of Cr than before treatment (P<0.05). At the end of the treatment, bronchoalveolar lavage lfuid culture MDR-Ab negative rate in observation group was signiifcantly higher than control group [80.9%(17/21) vs 42.8%(9/21), P<0.05], and 28-day mortality has no statistically signiifcant difference in both groups [23.8%(5/21) vs 33.3%(7/21) (P>0.05)]. Conclusion Treatment of multidrug-resistant acinetobacter baumannii ventilator-associated pneumonia by ifberoptic bronchoscopy lavage was better than intravenous administration of amikacin, and can achieve higher bacterial clearance rate, while effectively reducing nephrotoxicity.