陈佳炜

[摘要]目的 探讨大剂量美罗培南联合舒巴坦治疗多重耐药鲍曼不动杆菌肺炎的效果。方法 选取我院2011年6月～2016年8月收治的65例多重耐药鲍曼不动杆菌肺炎患者的临床资料进行分析，依据治疗措施不同进行分组，对照组30例采用普通剂量的美罗培南（1.0 g）联合舒巴坦进行治疗，观察组35例采用大剂量的美罗培南（2.0 g）联合舒巴坦进行治疗，两组患者均治疗5 d。观察两组患者治疗前后的血浆指标（PCT、CRP）、白细胞（WBC）计数水平情况及其临床疗效、不良反应情况。结果 两组治疗前的PCT、CRP、WBC计数差异均无统计学意义（P>0.05），治疗后，两组患者的PCT、CRP、WBC计数均低于治疗前，观察组患者治疗后的PCT、CRP、WBC计数均低于对照组，差异均有统计学意义（P<0.05）；观察组患者的总有效率高于对照组，差异有统计学意义（P<0.05）；两组患者的不良反应发生率差异无统计学意义（P>0.05）。结论 大剂量美罗培南联合舒巴坦治疗耐药鲍曼不动杆菌导致的多重耐药鲍曼不动杆菌肺炎的临床效果明显，无明显不良反应，值得临床推广应用。

[关键词]大剂量美罗培南；舒巴坦；多重耐药鲍曼不动杆菌；肺炎

[中图分类号] R563.1+9 [文献标识码] A [文章编号] 1674-4721（2017）04（c）-0026-03

[Abstract]Objective To explore the effect of Megadose Meropenem combined with Sulbactam treating pneumonia of multidrug resistant Acinetobacter Bauman.Methods The clinical data of 65 patients with pneumonia of multidrug resistant Acinetobacter Bauman treated in our hospital from June 2011 to August 2016 were selected to analyze.They were divided into two groups according to different therapeutic measures.In the control group （n=30），patients were treated by common dose of Meropenem （1.0 g） combined with Sulbactam，while in the observation group （n=35），high-dose of Meropenem （2.0 g） combined with Sulbactam was adopted.Patients were treated for five days.The plasma indexes （PCT，CRP），white blood cell count，clinical effect，and adverse reaction before and after therapy in the two groups were compared.Results The difference of PCT，CRP，WBC count of the two groups before treatment were not statistically significant （P>0.05），after treatment，PCT，CRP，WBC count in two groups were lower than that before treatment，and PCT，CRP，WBC count after treatment in the observation group were lower than those of the control group，the differences were statistically significant （P<0.05）.The total effective rate of the observation group was higher than that of the control group，the difference was statistically significant （P<0.05）.There was no significant difference in the incidence rate of adverse reactions between the two groups （P>0.05）.Conclusion The clinical effect of Megadose Meropenem combined with Sulbactam treating pneumonia of multidrug resistant Acinetobacter Bauman caused by drug resistant Acinetobacter Bauman is obvious，and it has no obvious adverse reactions，it is worthy of clinical promotion and application.

[Key words]Megadose Meropenem；Sulbactam；Multidrug resistant Acinetobacter Bauman；Pneumonia

鲍曼不动杆菌作为非发酵革兰阴性杆菌，属于临床常见的機会性致病菌，其也是一种耐药性强，依靠克隆传播的致病菌[1-2]。其多重耐药、泛耐药，几乎对于目前临床上各种抗生素均产生耐药性[3-4]。因鲍曼不动杆菌相关的耐药机制复杂多样，目前针对性治疗的抗生素应用报道较少。资料表明，鲍曼不动杆菌占临床分离的不动杆菌的70%以上，该菌对第三代和第四代头孢菌素，对阿米卡星、庆大酶素、奈替米星、妥布霉素四种氨基糖苷类，以及环丙沙星的耐药率均达50.0%以上，且近年来，关于鲍曼不动杆菌对碳青霉烯类抗生素耐药率逐步升高，给临床治疗带来了较大的难度[5-6]。本……