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目的探讨非抗生素治疗手段在泛耐药菌珠所致老年重症肺部感染疾病治疗中的可行性。方法选取2010年4月-2012年9月机械通气患者81例,根据治疗方案不同将患者分为A组36例及B组45例。A组治疗措施主要为应用胸腺肽类药物、丙种球蛋白免疫调节剂和血必净,每天进行1~2次的气管镜吸引及灌洗等。B组在A组的基础上继续给予经验性抗生素治疗。比较2组APACHEⅡ评分、白细胞数、体温及耐药性。结果 A组患者致病菌的耐药性由原来的100.0%广泛耐药特性降至55.2%,而B组患者致病菌耐药性未见明显改变;而白细胞含量经过非抗生素处理干预治疗后的A组白细胞数量有所下降,且与治疗前比较差异有统计学意义(P<0.05)。治疗1个月,A组死亡2例,病死率为5.6%,而B组死亡10例,病死率为22.2%,差异有统计学意义(P<0.01)。结论非抗生素治疗可使患者致病菌耐药性下降,降低病死率,具有可行性。
Objective To explore the feasibility of non-antibiotic treatment in the treatment of diseases of elderly patients with severe pulmonary infection caused by pan-resistant bacteria. Methods Eighty-one patients with mechanical ventilation were selected from April 2010 to September 2012. According to the different treatment options, the patients were divided into group A (36 cases) and group B (45 cases). A group of treatment measures mainly for the application of thymosin, gamma immunoglobulin immunosuppressive agents and Xuebijing, 1 to 2 times a day tracheal aspiration and lavage. Group B continued to receive empirical antibiotic therapy on the basis of Group A. The APACHE Ⅱ scores, white blood cell count, body temperature and drug resistance were compared between the two groups. Results The drug resistance of pathogenic bacteria in group A decreased from 100.0% to 55.2%, while the pathogenic bacteria in group B showed no significant change in drug resistance. However, after the treatment of non-antibiotic treatment of white blood cells The number of white blood cells in group A decreased, and the difference was statistically significant compared with that before treatment (P <0.05). One month after treatment, 2 cases died in group A, the case fatality rate was 5.6%, while in group B 10 cases died, the case fatality rate was 22.2%, the difference was statistically significant (P <0.01). Conclusion Non-antibiotic treatment can reduce the patient’s pathogenic bacteria drug resistance and reduce the mortality rate, which is feasible.