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| 降阶梯疗法治疗新生儿细菌感染性肺炎的疗效及对血清PCT、WBC和CRP的影响 |
| 作者：龚剑锋1 万华2 李秋红1 |
| 单位：1. 重庆市妇幼保健院 检验科, 重庆 401147; 2. 重庆市妇幼保健院 新生儿病房, 重庆 401147 |
| 关键词：新生儿 感染性肺炎 降阶梯疗法 炎症 |
| 分类号：R722.135 |
| 出版年·卷·期（页码）：2018·37·第五期（868-872） |
| 摘要： |
目的：探索抗生素降阶梯治疗策略治疗新生儿细菌感染性肺炎的临床效果及安全性。方法：将2015年6月至2017年5月收治的感染性肺炎新生儿88例，随机分为对照组（44例）和治疗组（44例）。治疗组采用亚胺培南西司他丁针剂，降阶梯为美洛西林或哌拉西林他唑巴坦继续治疗。对照组采用阿莫西林钠克拉维酸钾静脉滴注，效果不佳时更换第三代头孢菌素加酶抑制剂、联合用药或升级碳青霉烯类广谱抗生素进行治疗，直至临床痊愈出院。观察两组总有效率，记录患儿体温恢复正常、啰音消失、呼吸平稳和平均住院时间。治疗前后检测血清降钙素原（PCT）、白细胞计数（WBC）和C-反应蛋白（CRP）水平。结果：治疗组总有效率显著高于对照组（93.2%vs 77.3%，P<0.05）；治疗组体温恢复正常、啰音消失、呼吸平稳和平均住院时间均显著短于对照组（P<0.05）；经过治疗两组PCT、WBC和CRP水平均明显改善，治疗组改善效果显著优于对照组（P<0.05）。治疗过程中两组不良反应发生率差异无统计学意义（P>0.05）。结论：在新生儿细菌感染性肺炎早期采用抗生素降阶梯治疗可以缩短住院时间，改善临床症状，降低体内炎症因子水平，该疗法安全有效。 |
Objective:To explore the clinical efficacy and safety of antibiotics down-stepped therapeutic strategy in the treatment of neonatal bacterial infectious pneumonia. Methods:88 infants with infectious pneumonia admitted from June 2015 to May 2017 were randomly divided into the control group (44 cases) and the treatment group (44 cases). The treatment group received imipenem cilastatin injection, step down to continue to receive treatment of mezlocillin or piperacin tazobactam. In the control group, intravenous amoxicillin sodium and clavulanate potassium was used. When the clinical effect was poor, the third-generation cephalosporin plus enzyme inhibitors, combination therapy or upgraded carbapenem-type broad-spectrum antibiotics were used for treatment until clinical recovery. The total effective rate of the two groups were observed. The time of the children's body temperature returned to normal, rale disappearance, stable breathing and the average length of stay were recorded. Serum procalcitonin (PCT), white blood cell count (WBC) and C-reactive protein (CRP) levels were measured before and after treatment. Results:The total effective rate of the treatment group was significantly higher than that of the control group (93.2% vs 77.3%, P<0.05). The time of the children's body temperature returned to normal, rale disappearance, stable breathing and the average length of stay were significantly less than those of the control group (P<0.05); After treatment, PCT, WBC and CRP levels in the two groups were significantly improved, and the improvement effect in the treatment group was significantly better than that in the control group (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups during treatment (P>0.05). Conclusion:In the early stage of neonatal bacterial pneumonia, the use of antibiotics down-stepped therapy can shorten the hospital stay, improve the clinical symptoms and reduce the level of inflammation in the body, which is safe and effective. |
| 参考文献： |
[1] NAIR N S,LEWIS L E,LAKIANG T,et al.Risk factors and barriers to case management of neonatal pneumonia:protocol for a pan-India qualitative study of stakeholder perceptions[J].BMJ Open,2017,7(9):e017403. |
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