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目的观察支气管肺泡灌洗术联合抗菌药物阶梯疗法治疗小儿肺部感染的临床疗效。方法选取2014年8月—2015年8月在徐州市儿童医院ICU住院治疗的肺部感染患儿104例,根据治疗方式的不同分为观察组(n=50)和对照组(n=54)。对照组患儿给予常规第三代头孢菌素治疗;观察组患儿初期给予亚胺培南/西司他丁,而后按病原菌的药敏试验结果有针对性地选择窄谱敏感型抗菌药物治疗,并选择药敏试验显示敏感的抗生素给予支气管肺泡灌洗术。观察两组患儿临床疗效、疗效相关指标(体温恢复时间、肺部感染吸收所需时间、住ICU时间及住院时间),并分析分离出的革兰阴性菌对抗菌药物的耐药情况。结果观察组患儿的临床疗效优于对照组(P<0.05)。观察组患儿体温恢复时间、肺部感染吸收所需时间、住ICU时间、住院时间均短于对照组(P<0.05)。两组患儿共检出病原菌104株,其中革兰阴性菌89株(85.6%)。分析分离出的革兰阴性菌对抗菌药物的耐药率,其中肺炎克雷伯菌、大肠埃希菌、鲍曼不动杆菌及阴沟肠杆菌均对亚胺培南和美罗培南的耐药率最低,为0;而铜绿假单胞菌对头孢哌酮/舒巴坦的耐药率最低,为0。结论支气管肺泡灌洗术联合抗菌药物阶梯疗法治疗小儿肺部感染疗效较好,且能够促进患儿症状的恢复。
Objective To observe the clinical efficacy of bronchoalveolar lavage combined with antimicrobial ladder therapy in children with pulmonary infection. Methods A total of 104 children with pulmonary infection hospitalized in ICU of Xuzhou Children’s Hospital from August 2014 to August 2015 were selected and divided into observation group (n = 50) and control group (n = 54) according to different treatment methods. . Control group of children given conventional third-generation cephalosporins treatment; observation group infants initially given imipenem / cilastatin, and then according to the pathogen susceptibility test results targeted narrow-spectrum sensitive antibiotic treatment , And the choice of susceptibility test showed that sensitive antibiotics given bronchoalveolar lavage. The clinical curative effect and curative effect index (body temperature recovery time, the time needed for lung infection absorption, ICU stay and hospital stay) of two groups were observed and the antibiotic resistance of Gram-negative bacteria was analyzed. Results The clinical efficacy of the observation group was better than that of the control group (P <0.05). The body temperature recovery time, the time required for lung infection absorption, ICU stay and hospital stay in observation group were shorter than those in control group (P <0.05). A total of 104 pathogenic bacteria were detected in both groups, of which 89 were Gram-negative bacteria (85.6%). The antibiotic resistance rates of Gram-negative bacteria were analyzed. Among them, Klebsiella pneumoniae, Escherichia coli, Acinetobacter baumannii and Enterobacter cloacae showed the lowest resistance rate to imipenem and meropenem , And 0, while P. aeruginosa had the lowest resistance rate to cefoperazone / sulbactam. Conclusion Bronchoalveolar lavage combined with antimicrobial ladder therapy in children with pulmonary infection is better, and can promote the recovery of children’s symptoms.