目的 探討多粘菌素B聯(lián)合頭孢哌酮鈉舒巴坦鈉和替加環(huán)素對多重耐藥鮑曼不動桿菌肺炎患者的療效及安全性。方法 選擇2017年9月-2019年9月在新疆維吾爾自治區(qū)人民醫(yī)院收治的80例多重耐藥鮑曼不動桿菌肺炎患者作為研究對象，按照治療方法的不同分為對照組與觀察組，每組各40例。對照組患者靜脈滴注注射用頭孢哌酮鈉舒巴坦鈉，3 g加入到0.9%氯化鈉溶液中，每隔12 h靜滴，2 h之后靜滴注射用替加環(huán)素，首劑用量100 mg，之后每隔12 h靜滴50 mg進(jìn)行維持，2次/d。觀察組在對照組治療的基礎(chǔ)上靜脈滴注注射用硫酸多粘菌素B，100~150萬單位/d，分2~3次靜脈滴注。兩組療程共14 d。觀察兩組患者的臨床療效和細(xì)菌清除率，比較兩組患者白細(xì)胞計數(shù)（WBC）、血清C反應(yīng)蛋白（CRP）、降鈣素原（PCT）水平。結(jié)果 治療后，兩組總有效率比較差異沒有統(tǒng)計學(xué)意義。治療后，兩組患者的WBC、CRP和PCT水平均較治療前明顯降低（P<0.05），且觀察組患者WBC、CRP和PCT水平顯著低于對照組（P<0.05）。治療后，觀察組的細(xì)菌清除率為87.5%，明顯高于對照組的62.5%，兩組比較差異有統(tǒng)計學(xué)意義（P<0.05）。結(jié)論 多粘菌素B聯(lián)合頭孢哌酮鈉舒巴坦鈉和替加環(huán)素治療多重耐藥鮑曼不動桿菌肺炎效果較好，值得臨床推廣。

Objective To investigate the efficacy and safety of polymyxin B combined with cefoperazone sodium and sulbactam sodium and tigecycline in treatment of patients with multi-drug resistant acinetobacter Baumannii pneumonia. Methods A total of 80 patients with multidrug-resistant acinetobacter Baumannii pneumonia admitted to the People's Hospital of Xinjiang Uygur Autonomous Region from September 2017 to September 2019 were selected as the research subjects and divided into control group and observation group according to different treatment methods, with 40 cases in each group. Patients in the control group were iv administered with Cefoperazone Sodium and Sulbactam Sodium for injection, 3 g was added to 0.9% sodium chloride solution, intravenous infusion every 12 h, 2 h later, intravenous infusion of Tigecycline for Injection, the first dose was 100 mg, and then intravenous infusion of 50 mg every 12 h for maintenance, twice daily. Patients in the observation group was iv administered given Polymyxin B Sulfate for Injection on the basis of control group, 1 to 1.5 million U/d, divided into 2 to 3 intravenous infusion. Patients in two groups were treated for 2 weeks. After treatment, clinical efficacy and bacterial clearance rate of two groups were observed, and the levels of WBC, CRP and PCT were compared. Results After treatment, there was no significant difference in total effective rate between two groups. After treatment, the levels of WBC, CRP, and PCT in two groups were significantly lower than those before treatment (P<0.05), and the levels of WBC, CRP, and PCT in observation group were significantly lower than those in control group (P<0.05). After treatment, the bacterial clearance rate of the observation group was 87.5%, which was significantly higher than 62.5% of the control group, and the difference between two groups was statistically significant (P<0.05). Conclusion Polymyxin B combined with cefoperazone sodium and sulbactam sodium and tegecyclin in treatment of multi-drug resistant acinetobacter Baumannii pneumonia has a good effect, and is worthy of clinical promotion.

R974

新疆維吾爾自治區(qū)自然科學(xué)基金（2020D01C100）