三联抗感染治疗多重耐药革兰阴性杆菌重症肺炎16例临床观察

目的评价予亚胺培南/西司他丁联合左氧氟沙星或阿米卡星静注、克拉霉素鼻饲三联抗感染治疗多重耐药(multidrug-resistant,MDR)革兰阴性杆菌重症肺炎的疗效。方法对我院ICU 2010年1月至2013年12月收治16例无多器官功能障碍综合征耐药革兰阴性杆菌重症肺炎危重患者,在单用抗生素治疗3⁷ d无效后,选用亚胺培南/西司他丁联合左氧氟沙星或阿米卡星静注、克拉霉素鼻饲三联抗感染治疗,药物剂量依患者年龄、体质量、肝肾功能调整,疗程147 d无效后,选用亚胺培南/西司他丁联合左氧氟沙星或阿米卡星静注、克拉霉素鼻饲三联抗感染治疗,药物剂量依患者年龄、体质量、肝肾功能调整,疗程14²8 d,观察和评估其临床疗效。结果本组患者肺部感染得到控制转出ICU 8例(占50%),放弃治疗转出ICU 3例(占18.75%),死亡5例(占31.25%)。结论对原发病好转及肝肾功能无恶化的多重耐药革兰阴性杆菌重症肺炎危重患者予亚胺培南/西司他丁联合左氧氟沙星或阿米卡星静注、克拉霉素鼻饲三联抗感染治疗方案,能够获得较好的疗效,值得临床推广及应用。

Clinical Observation of Combined Treatment in 16 Cases of MDR Gram-negative Bacillary Severe Pneumonia

Objective To evaluate the combined treatment of imipenem/cilastatin sodium, levofloxacin or amikacin for injection and nasal feeding clarithromycin in MDR gram-negative bacillary severe pneumonia. Methods 16 patients out of multiple organ dysfunction syndrome with MDR gramnegative bacillary severe pneumonia admitted by ICU from Jan 2010 to Dec 2013 were observed and evaluated, who were use one antibiotic 3-7days but ineffective, treated combinedly by imipenem/cilastatin sodium, levofloxacin or amikacin for injection and oral clarithromycin in 14-28 days, dose adjusted according to the patient＇s age, weight, liver and kidney function, after using imipenem/cilastatin sodium singly were unvalaible. Results 8 cases were improved and discharged（50%）, 3 for relinquishment（18.75%） and 5 for death（31.25%）. Conclusion It may be a better scheme to use imipenem/cilastatin sodium, levofloxacin or amikacin for injection and nasal feeding clarithromycin combinedly in MDR gram-negative bacillary severe pneumonia, who were protopathy improve and hepatorenal function no deterioration.