国产利奈唑胺治疗革兰氏阳性球菌感染重症肺炎患者疗效评价及其影响因素分析
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摘要
目的探讨国产利奈唑胺治疗革兰氏阳性球菌感染重症肺炎患者的疗效及其影响因素。方法以安阳市人民医院2016年1月—2017年12月收治的80例革兰氏阳性球菌感染重症肺炎患者作为研究对象,并采用前瞻性研究。其中42例患者使用国产利奈唑胺进行治疗(观察组),38例患者使用去甲万古霉素进行治疗(对照组),观察并比较2组患者的治疗效果。同时根据治疗是否有效,将其分为有效组(n=49)与无效组(n=31),并通过logistic回归模型分析影响患者预后的危险因素。结果治疗后,观察组患者MDA、IL-1β和TNF-α水平明显低于对照组(P<0.05),而该组患者SOD、LHP、TGF-β、血气分析指标、肺功能指标水平明显高于对照组(P<0.05);观察组患者治疗总有效率明显高于对照组(73.81%vs 47.37%,P<0.05);logistic回归分析结果表明APACHEⅡ评分、72 h内累积液体总出入量是否为正平衡、通气方式等均为影响患者预后的独立危险因素。结论采用国产利奈唑胺治疗革兰氏阳性球菌感染重症肺炎患者,能有效改善其肺功能,降低机体炎性反应,治疗效果显著。另外,针对72 h内累积液体总出入量是否为正平衡、通气方式等独立危险因素,应及时采取预防措施,提高患者预后。
OBJECTIVE To study on efficiency of domestic linazolamide in the treatment process of severe pneumonia infected with gram-positive cocci and its influencing factors. METHODS The 80 patients with severe pneumonia infected with gram-positive cocci were treated in Anyang People's Hospital from January 2016 to December 2017. They were considered as study objects and were analyzed prospectively. They were divided into observation group treated with domestic linzolamide(n=42) and control group treated with norvancomycin(n=38). The treatment effects were observed and compared. At the same time, according to the recurrence or not for these patients, they were divided into efficiency group(n=49) and non-efficiency group(n=31). The risk of prognostic factors were analyzed by logistic regression model. RESULTS After treatment, the index including MDA, IL-1β and TNF-α were significantly lower in observation group compared with the control group(P<0.05), while the level of SOD, LHP, TGF-b, blood gas analysis index and lung function index in observation group was higher than that of control group(P<0.05). The effective rate in the observation group was significantly higher than the control group(73.81% vs 47.37%, P<0.05). The results of logistic regression analysis showed that APACHEⅡ, whether the total volume of cumulative fluid in 72 h was in a positive balance, and the ventilation pattern were independent risk factors for the prognosis of the patients. CONCLUSION Domestic linazolamide is used in the treatment process of severe pneumonia infected with gram-positive cocci, and it can effectively improve the pulmonary function of the patients and reduce the inflammatory reaction of the body. The therapeutic effect is remarkable. In addition, preventive measures shall be taken in time to improve the prognosis of patients with need for mechanica 1 ventilation and positive balance of fluid accumulationin 72 h.
OBJECTIVE To study on efficiency of domestic linazolamide in the treatment process of severe pneumonia infected with gram-positive cocci and its influencing factors. METHODS The 80 patients with severe pneumonia infected with gram-positive cocci were treated in Anyang People's Hospital from January 2016 to December 2017. They were considered as study objects and were analyzed prospectively. They were divided into observation group treated with domestic linzolamide(n=42) and control group treated with norvancomycin(n=38). The treatment effects were observed and compared. At the same time, according to the recurrence or not for these patients, they were divided into efficiency group(n=49) and non-efficiency group(n=31). The risk of prognostic factors were analyzed by logistic regression model. RESULTS After treatment, the index including MDA, IL-1β and TNF-α were significantly lower in observation group compared with the control group(P<0.05), while the level of SOD, LHP, TGF-b, blood gas analysis index and lung function index in observation group was higher than that of control group(P<0.05). The effective rate in the observation group was significantly higher than the control group(73.81% vs 47.37%, P<0.05). The results of logistic regression analysis showed that APACHEⅡ, whether the total volume of cumulative fluid in 72 h was in a positive balance, and the ventilation pattern were independent risk factors for the prognosis of the patients. CONCLUSION Domestic linazolamide is used in the treatment process of severe pneumonia infected with gram-positive cocci, and it can effectively improve the pulmonary function of the patients and reduce the inflammatory reaction of the body. The therapeutic effect is remarkable. In addition, preventive measures shall be taken in time to improve the prognosis of patients with need for mechanica 1 ventilation and positive balance of fluid accumulationin 72 h.
引文
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[10]ZHOU J J,LIANG P P,WANG R,et al.Bactericidal activity of linezolid and vancomycin against methicillin-resistant Staphylococcus aureus in vitro[J].Chin J Clin Pharmacol(中国临床药理学杂志),2010,26(8):593-596.
[11]CAI S S,LONG Y,LIU N,et al.Changes of lipid peroxidation,inflammatory factors,adiponectin and endothelial function in rats with acute uric acid exacervation[J].J Clin Exper Med(临床和实验医学杂志),2018,17(14):1469-1472.
[12]YANG X Q,LI G P,WANG X Y,et al.Key factor of pneumonia’s occurrence and aggravation:oxidative stress-DNA damage[J].Internat J Respirat(国际呼吸杂志),2016,36(17):1308-1313.
[13]LIU S H,WEN J L,QIU P,et al.Levels and clinical significances of cytokines in serum and bronchoalveolar lavage fluid in patients with severe pneumonia[J].Chin JNosocomiol(中华医院感染学杂志),2016,26(24):5587-5589.
[14]YAO L X.Changes and its clinical significance of IL-10,TNF-αand TGF-β1 in senile patients with pneumonia myco-plasma infection[J].J Clin Pulmon Med(临床肺科杂志),2015,20(7):1278-1281.
[15]QIAN S H,LI Y F,FU L,et al.Expression and significance of IL-10,IL-17 and VEGF in children with mycoplasma pneumoniae pneumonia complicated with wheezing[J].Lab Immun Clin Med(标记免疫分析与临床),2016,23(12):1369-1371.
[16]XU Y Q,JIE J.Ventilator associated pneumonia[J].Shandong Med J(山东医药),2013,43(31):58-59.
[2]HUANG J W,XIAO Q,WU J Y,et al.Characteristics and duration of hospitalization among middle-aged and elderly patients with community-acquired pneumonia[J].Chin JEpidemiol(中华流行病学杂志),2017,38(4):542-546.
[3]CHEN P,LIU D.Clinical application of glycopeptide antibiotics in hospitalized patients[J].Chin J Infect Control(中国感染控制杂志),2017,16(5):429-433.
[4]FANG R,WANG Q,FENG L W,et al.Efficacy and mechanism of linezolid injection combined with thymosin in treatment of severe pneumonia[J].J North Sichuan Med Coll(川北医学院学报),2016,31(3):396-399.
[5]中华医学会呼吸学分会.社区获得性肺炎诊断和治疗指南[J].中华结核和呼吸杂志,2006,29(10):651-655.
[6]CHEN H Y,ZHANG J.Effect of combination with the thymosin alpha 1 in elderly severe pneumonia[J].Mod Med J(现代医学),2013,41(4):255-258.
[7]ZHANG Y X,PENG H,JIANG Y P,et al.Dynamic analysis of distribution and antimicrobial resistance of cesarean section postoperative infection of elderly maternal[J].Chin J Mod Appl Pharm(中国现代应用药学),2017,34(8):1193-1197.
[8]MANDELL L A,WUNDERINK R G,ANZUETO A,et al.Infectious diseases society of America/American thoracic society consensus guidelines on the management of communityacquired pneumonia in adults[J].Clin Infect Disease,2007,44(suppl 2):S27-S34.
[9]HUAN Q H,YOU Y X,YAN S S.Clinical study on Yuxingcao injection combined with linezolid in treatment of pneumonia infected by methicillin resistant staphylococcus aureus[J].Drugs&Clinic(现代药物与临床),2017,32(10):1895-1898.
[10]ZHOU J J,LIANG P P,WANG R,et al.Bactericidal activity of linezolid and vancomycin against methicillin-resistant Staphylococcus aureus in vitro[J].Chin J Clin Pharmacol(中国临床药理学杂志),2010,26(8):593-596.
[11]CAI S S,LONG Y,LIU N,et al.Changes of lipid peroxidation,inflammatory factors,adiponectin and endothelial function in rats with acute uric acid exacervation[J].J Clin Exper Med(临床和实验医学杂志),2018,17(14):1469-1472.
[12]YANG X Q,LI G P,WANG X Y,et al.Key factor of pneumonia’s occurrence and aggravation:oxidative stress-DNA damage[J].Internat J Respirat(国际呼吸杂志),2016,36(17):1308-1313.
[13]LIU S H,WEN J L,QIU P,et al.Levels and clinical significances of cytokines in serum and bronchoalveolar lavage fluid in patients with severe pneumonia[J].Chin JNosocomiol(中华医院感染学杂志),2016,26(24):5587-5589.
[14]YAO L X.Changes and its clinical significance of IL-10,TNF-αand TGF-β1 in senile patients with pneumonia myco-plasma infection[J].J Clin Pulmon Med(临床肺科杂志),2015,20(7):1278-1281.
[15]QIAN S H,LI Y F,FU L,et al.Expression and significance of IL-10,IL-17 and VEGF in children with mycoplasma pneumoniae pneumonia complicated with wheezing[J].Lab Immun Clin Med(标记免疫分析与临床),2016,23(12):1369-1371.
[16]XU Y Q,JIE J.Ventilator associated pneumonia[J].Shandong Med J(山东医药),2013,43(31):58-59.