抗生素降阶梯治疗重症肺炎的临床疗效及安全性

目的：比较抗生素降阶梯方案与传统抗生素方案治疗重症肺炎的临床疗效及安全性。方法将2013年1月至2015年1月在本院呼吸科住院的100例重症肺炎患者按照随机数表法分为观察组和对照组各50例，观察组患者给予抗生素降阶梯治疗方案，对照组给予传统抗生素方案。治疗7d后，比较两组患者的临床疗效，治疗前后C反应蛋白(CRP)、D-二聚体(D-D)、降钙素原(PCT)的变化，以及抗生素静脉用药时间、感染控制时间、病死率、肺部啰音消失时间、平均住院时间、痰细菌培养结果。结果观察组患者的治疗总有效率为88.00%(44/50)，二次感染率为8.00%(4/50)，总有效率明显高于对照组的72.00%(36/50)，二次感染率明显低于对照组的28.00%(14/50)，且差异均有统计学意义(P<0.01)；两组患者治疗前的CRP、D-D、PCT水平比较差异均无统计学意义(P>0.05)；治疗后，两组患者CRP、D-D、PCT均有所下降，且观察组下降明显低于对照组，差异有统计学意义(P<0.05)；与对照组比较，观察组患者的抗生素静脉用药时间、感染控制时间、肺部啰音消失时间、平均住院时间明显低于对照组，病死率明显低于对照组，两组比较差异均有统计学意义(P<0.05)；观察组患者的细菌清除率为87.04%(47/54)，明显高于对照组的52.17%(24/46)，差异有统计学意义(P<0.05)。结论抗生素降阶梯治疗方案治疗重症肺炎临床疗效优于传统方案，且安全性较高，值得临床推广使用。

Clinical efficacy and safety of de-escalation therapy of antibiotics for severe pneumonia

Objective To compare the clinical efficacy and safety of de-escalation therapy of antibiotics for se-vere pneumonia. Methods A total of 100 cases of severe pneumonia, who admitted to the Department of Respiratory Medicine of our hospital from January 2013 to January 2015, were divided into observation group and control group ac-cording to the random number table method, with 50 cases in each group. The observation group received antibiotics de-escalation therapy of antibiotics. The control group was given traditional antibiotic regimens. After seven days of treatment, the clinical efficacy, C reactive protein (CRP), D-dimer (D-D), procalcitonin (PCT) changes, intravenous anti-biotic medication time, infection control time, mortality, pulmonary rales disappearance time, average hospitalization time, sputum bacterial culture and drug sensitivity detection results of two groups were compared. Results The total ef-fective rate of the observation group 88.00%(41/50)] was significantly higher than that of the control group 72.00%(36/50)];The rate of second infection of the observation group 8.00%(4/50)] was significantly lower than that of the control group 28.00%(14/50)], P<0.05. Before treatment, there was no significant difference between the two groups in CRP, D-D and PCT (P>0.01). After treatment, CRP, D-D, PCT of two groups decreased, and the decrease of CRP, D-D and PCT of the observation group were significantly lower than those of the control group (P<0.05). The intravenous an-tibiotics time, medication time control time, pulmonary rales disappeared time, average hospitalization time and mor-tality of observation group were significantly lower than those of control group (P<0.05). The bacterial clearance rate of observation group 87.04%(47/54)] was significantly higher than that of control group 52.17%(24/46)], P<0.05. Conclusion Antibiotic de-escalation therapy in the treatment of severe pneumonia is safe and effective, which is better than the traditional method and worthy of clinical promotion.