朱秋娟++王丽娜++卫芬++边思成

[摘要] 目的 评价利奈唑胺注射液联合亚胺培南西司他丁钠治疗粒细胞缺乏伴发热患者的临床疗效及安全性。 方法 方便选取山西大医院2013年1月—2016年12月期间收治的107例血液病粒细胞缺乏伴发热患者随机分为A（n=53）、B（n=54）两组，分别接受利奈唑胺联合亚胺培南西司他丁钠、盐酸万古霉素联合亚胺培南西司他丁钠静脉滴注治疗，比较两组的临床疗效和安全性。 结果 A、B两组临床治疗总有效率分别为 75.5% 和 72.2%（P>0.05），药物不良反应发生率分别为3.77%和16.67% （P<0.05），A组有效病例退热时间为（1.8±0.3）d，与B组（3.5±0.8）d比较，差异有统计学意义（t=14.50，P<0.05）。结论 与盐酸万古霉素联用亚胺培南西司他丁钠静脉滴注治疗中性粒细胞缺乏伴发热比较，利奈唑胺联用亚胺培南西司他丁钠与其临床疗效相似，但退热起效时间快，且安全性更高。

[关键词] 利奈唑胺；亚胺培南西司他丁钠；万古霉素；粒细胞缺乏伴发热

[中图分类号] R4 [文献标识码] A [文章编号] 1674-0742（2017）05（b）-0125-03

[Abstract] Objective To evaluate the clinical curative effect and safety of linezolid and imipenem and cilastatin sodium in treatment of patients with hematonosis agranulocytosis with fever. Methods 107 cases of patients with hematonosis agranulocytosis with fever admitted and treated in our hospital from January 2013 to December 2016 were convenient selected and randomly divided into two groups， the group A with 53 cases were treated with linezolid and imipenem and cilastatin sodium， while the group B with 54 cases adopted the intravenous drip of vancomycin hydrochloride and imipenem and cilastatin sodium， and the clinical curative effect and safety were compared between the two groups. Results The differences in the total effective rate between the group A and group B were not statistically significant（75.5% vs 72.2%）（P>0.05）， and the difference in the incidence rate of adverse reactions of drugs between the group A and group B were statistically significant（3.77% vs 16. 67%）（P<0.05）， and the difference in the effective case defervescence time between the group A and group B was statistically significant[（1.8±0.3）d vs（3.5±0.8）d] （t=14.50， P<0.05）. Conclusion The clinical curative effect of linezolid and imipenem and cilastatin sodium in treatment of patients with hematonosis agranulocytosis with fever is similar to that of vancomycin hydrochloride and imipenem and cilastatin sodium， and the defervescence onset time is rapid and the safety is higher.

[Key words] Linezolid； Imipenem and cilastatin sodium； Vancomycin； Agranulocytosis with fever

中性粒细胞缺乏常见于血液病患者放化疗后或原发性血液病[1]，患者感染往往以发热为主要表现，且常因耐药球菌的感染，而导致发热时间的延长，一般单独抗菌治疗效果差且严重感染发生率高[2]，因此临床上常考虑联合用药。万古霉素常和碳青霉烯类药物联用治疗该病，但药物不良反应和药物耐受性限制了其在临床的应用[3]，利奈唑胺对耐万古霉素肠球菌、耐青霉素肺炎球菌和厌氧菌均有较强的抗菌活性，且不良反应较小，不易产生耐药，为优选该病治疗方案，笔者方便选取2013年1月—2016年12月期间该院收治的107例血液病粒细胞缺乏伴感染患者，对接受万古霉素注射剂或利奈唑胺注射剂治疗的临床疗效及安全性进行评价，现报道如下。

1 资料与方法

1.1 一般资料

方便选取该院血液科收治的血液病中性粒细胞缺乏伴发热使用亚胺培南西司他丁钠治疗的患者107例，所有患者均符合粒细胞缺乏症的诊断标准[4]，且自愿配合相关治疗。排……