注射用阿齐霉素治疗儿童肺炎的疗效及安全性观察

目的　探讨注射用阿齐霉素治疗儿童细菌性肺炎的疗效及安全性。方法　2 0 0 3年1月～2 0 0 3年9月,应用注射用阿齐霉素治疗10 0例细菌性肺炎患者,阿齐霉素剂量按10 mg/ ( kg·d)加入葡萄糖溶液,每天1次静滴,疗程5～7d,观察治疗前后症状体征的变化以及外周血象、肝肾功能及X线胸片变化,并取咽部或上呼吸道分泌物做细菌培养及阿齐霉素药敏试验。结果　注射用阿齐霉素临床总有效率为93.0 % ,不良反应发生率为11.0 % ,不良反应症状轻微。结论　注射用阿齐霉素治疗儿童细菌性肺炎疗效满意,安全性高     

头孢曲松钠联合阿奇霉素治疗儿童重症社区获得性肺炎临床观察

目的观察头孢曲松钠联合阿奇霉素治疗儿童重症社区获得性肺炎的疗效。方法92例重症社区获得性肺炎患儿随机分为治疗组和对照组,各46例。对照组给予头孢曲松钠50～80mg／（kg·d）静脉滴注治疗;治疗组在对照组基础上加用阿奇霉素10mg/（kg·d）静脉滴注治疗,连用5～7d。结果治疗组在退热、肺部哕音及咳嗽消失时间、平均住院时间均较对照组短,差异有非常显著性（P〈0．01）。结论头孢曲松钠联合阿奇霉素治疗儿童重症社区获得性肺炎效果明显,不良反应少,值得临床推广。     

阿奇霉素联合左氧氟沙星治疗社区老年吸入性肺炎的疗效分析

目的观察阿奇霉素联合左氧氟沙星治疗社区老年吸入性肺炎的临床疗效。方法回顾性分析长寿社区卫生服务站2011年3月至2014年6月收治的52例老年吸入性肺炎患者的临床资料。其中采用左氧氟沙星治疗者26例(对照组),采用阿奇霉素联合左氧氟沙星治疗者26例(观察组)。结果观察组消热消退时间、呼吸困难改善时间、吸痰次数、病灶吸收时间改善情况均优于对照组(t=5.3051、5.9898、16.1115、9.8448,均P0.05)。观察组总有效率(92.3%)显著性高于对照组的总有效率(61.5%),两组相比差异具有统计学意义(χ2=6.933,P0.05)。结论阿奇霉素联合左氧氟沙星治疗社区老年吸入性肺炎的临床症状改善所需时间短,临床疗效好,值得推广。     

阿莫西林克拉维酸钾联合阿奇霉素治疗社区获得性肺炎的临床疗效研究

目的:探讨阿莫西林克拉维酸钾联合阿奇霉素治疗社区获得性肺炎(CAP)的临床疗效。方法:选取于2010年1月-2012年1月收治的CAP患者145例,采用随机数字表法将其分为两组,其中治疗组73例,对照组72例。治疗组给予阿莫西林克拉维酸钾联合阿奇霉素治疗,对照组只单纯给予应用阿莫西林克拉维酸钾。两组疗程均为7~14 d。于治疗后比较两组的临床疗效。结果:(1)治疗组治愈、显效、有效、无效分别为43例(58.9%)、16例(21.9%)、8例(11.0%)、6例(8.2%);对照组分别为20例(27.8%)、26例(36.1%)、14例(19.4%)、12例(16.7%)。两组疗效比较,差异有统计学意义(P0.05)。(2)治疗组胃肠道反应、静脉滴注局部疼痛、皮疹的发生分别为6例(8.2%)、7例(9.6%)、3例(4.1%),总不良反应发生率为16例(21.9%);对照组分别为5例(6.9%)、6例(8.3%)、3例(4.2%)、14例(19.4%)。两组不良反应发生率比较,差异无统计学意义(P0.05)。结论:阿莫西林克拉维酸钾联合阿奇霉素治疗CAP疗效好。     

哌拉西林舒巴坦联合莫西沙星治疗社区获得性肺炎的临床观察

目的:探讨哌拉西林舒巴坦与莫西沙星联用治疗社区获得性肺炎的临床效果。方法:随机选取2015年3月--2016年3月在我院呼吸科病区住院的90例社区获得性肺炎患者,并随机分为观察组(28例)、对照A组(31例)对照B组(31例)。观察组患者采用哌拉西林舒巴坦粉针3.75 g,bid,联合莫西沙星0.4 g,静脉注射,qd,对照A组患者则单用哌拉西林舒巴坦粉针3.75 g,静脉滴注,bid,对照B组患者采用单用莫西沙星0.4 g,静脉注射,qd,三组患者的治疗时间均为10 d。治疗结束后,比较两组患者的临床症状改善情况及不良反应的发生情况。结果:治疗10天后,观察组患者治疗后肺部浸润性阴影、肺部啰音、胃肠道情况及体温等均显著好转,观察组患者的临床治疗有效情况显著高于对照A组(100%vs 87.09%,P0.05),对照B组的有效率也较A组提高(96.77%vs 87.09%,P0.05)。观察组总体治愈率显著高于对照A组(92.86%vs 51.61%),对照B组的总体治愈率显著高于对照A组(70.97%vs 51.61%),但观察组和对照B组之间并无显著性差异(p0.05)。观察组、对照A组、对照B组的细菌清除率分别为92.86%、74.19%、90.32%,观察组和对照B组的清除率显著高于对照A组;三组的不良反应发生率比较并无显著性差异(P0.05)。结论:哌拉西林舒巴坦联合莫西沙星治疗社区获得性肺炎的效果显著优于单用哌拉西林舒巴坦治疗的效果,稍优于单用莫西沙星的治疗效果,安全性较高。     

老年社区获得性肺炎患者TNF-α和sTREM-1的表达及临床意义

目的:探讨老年社区获得性肺炎患者TNF-α和sTREM-1表达水平及其临床意义。方法:从我院选择48例社区获得性肺炎患者为CAP组(重症组和普通组),另选取对照组48例。收集两组患者的血浆及BALF,分别收集重症组患者住院后1天、4天的血浆和BALF,对比各组sTREM-1和TNF-α的表达水平。结果:对照组TNF-α和sTREM-1的表达水平均低于CAP组(P0.05);重症患者的TNF-α和sTREM-1表达水平高于普通组和健康对照组(P0.05)。重症患者TNF-α表达水平与对照组无显著差异(P0.05),而s TREM-1表达高于对照组,差异有统计学意义(P0.05)。结论:TNF-α和sTREM-1表达水平与CAP的发病过程密切相关,其表达水平与CAP的严重程度呈正相关。     

喜炎平佐治小儿社区获得性肺炎86例临床疗效分析

目的:总结喜炎平辅助治疗小儿社区获得性肺炎的临床治疗效果。方法:选择小儿社区获得性肺炎86例,随机分为治疗组44例和对照组42例,两组均予抗生素及支持对症等治疗,治疗组在规范治疗基础上加用喜炎平注射液。观察并记录两组患儿发热、咳喘、肺部啰音消失时间及住院天数。结果:治疗组在退热、平喘、消散肺部湿啰音及住院天数方面与对照组比较有显著性差异(P<0.05)。结论:喜炎平辅助治疗小儿社区获得性肺临床疗效肯定。     

喜炎平佐治小儿社区获得性肺炎86例临床疗效分析

目的：总结喜炎平辅助治疗小儿社区获得性肺炎的临床治疗效果。方法：选择小儿社区获得性肺炎86例,随机分为治疗组44例和对照组42例,两组均予抗生素及支持对症等治疗,治疗组在规范治疗基础上加用喜炎平注射液。观察并记录两组患儿发热、咳喘、肺部啰音消失时间及住院天数。结果：治疗组在退热、平喘、消散肺部湿啰音及住院天数方面与对照组比较有显著性差异（P〈0.05）。结论：喜炎平辅助治疗小儿社区获得性肺临床疗效肯定。     

老年社区获得性肺炎患者TNF-alpha和sTREM-1 的表达及临床意义

目的:探讨老年社区获得性肺炎患者TNF-α和s TREM-1表达水平及其临床意义。方法:从我院选择48例社区获得性肺炎患者为CAP组(重症组和普通组),另选取对照组48例。收集两组患者的血浆及BALF,分别收集重症组患者住院后1天、4天的血浆和BALF,对比各组s TREM-1和TNF-α的表达水平。结果:对照组TNF-α和s TREM-1的表达水平均低于CAP组(P<0.05);重症患者的TNF-α和s TREM-1表达水平高于普通组和健康对照组(P<0.05)。重症患者TNF-α表达水平与对照组无显著差异(P>0.05),而s TREM-1表达高于对照组,差异有统计学意义(P<0.05)。结论:TNF-α和s TREM-1表达水平与CAP的发病过程密切相关,其表达水平与CAP的严重程度呈正相关。     

国产阿齐霉素治疗细菌感染的研究

２０７例细菌性感染疾病患者,其中１０７例用国产阿齐霉素片治疗与１００例用进口阿齐霉素胶囊治疗进行随机对照观察,结果两组痊愈率分别为５２．３４％和６３％,有效率各为９３．４６％和９２％,两组临床症状、体征消退时间相似,二组细菌清除率分别为９６．４３％和９４％,二组不良反应发生率少而轻微,分别为１．８７％和１％,上述结果表明国产阿齐霉素片治疗细菌性感染与进口阿齐霉素同样安全有效。     

经验性治疗社区获得性肺炎中的疗效评价

目的 评价β-内酰胺类抗生素联合大环内酯类与单用氟喹诺酮类治疗社区获得性肺炎的疗效.方法 收集符合纳入及排除标准的2010年1月1日至2011年6月30日期间就诊于浙江大学医学院附属第一医院的社区获得性肺炎临床资料并进行分析.结果 有89例病例纳入本次研究,其中56例接受β-内酰胺类抗生素加大环内酯类,33例单用氟喹诺酮类治疗.两组患者在年龄,性别组成,合并症,入院前抗生素治疗,影响体温药物的应用,体征及部分实验室检查等方面差异均无统计学意义(P＞0.05).在临床疗效评价上,两组在入院后退热时间、住院时长及CRP下降80％时间差异均无统计学意义(P＞0.05),根据PSI进行亚组分析差异亦无统计学意义.结论 β-内酰胺类抗生素联合大环内酯类与单用氟喹诺酮类在治疗轻中度社区获得性肺炎时,二者疗效相当.     

Value of rapid aetiological diagnosis in optimization of antimicrobial treatment in bacterial community acquired pneumonia

In 80 adult patients with community acquired pneumonia (CAP) conventional microbiological methods, polymerase chain reaction (PCR) and serum C-reactive protein (CRP) levels were performed and the appropriateness of the empirical antimicrobial treatment was evaluated according to bacterial pathogen detected. The aetiology was determined in 42 (52.5%) patients, with Streptococcus pneumoniae as the most common pathogen. PCR applied to bronchoalveolar lavage (BAL) provided 2 and PCR on sputum samples 1 additional aetiological diagnosis of CAP The mean CRP values in the S. pneumoniae group were not significantly higher than in the group with other aetiological diagnoses (166.89 mg/L vs. 160.11 mg/L, p = 0.457). In 23.8% (10/42) of patients with determined aetiology, the empirical antimicrobial treatment was inappropriate. PCR tests need further investigation, particularly those for the atypical pathogens, as they are predominant in inappropriately treated patients. Our results do not support the use of CRP as a rapid test to guide the antimicrobial treatment in patients with CAP.     

阿莫西林克拉维酸钾联合阿奇霉素治疗社区获得性肺炎的临床疗效研究

目的：探讨阿莫西林克拉维酸钾联合阿奇霉素治疗社区获得性肺炎（CAP）的临床疗效。方法：选取于2010年1月-2012年1月收治的CAP患者145例,采用随机数字表法将其分为两组,其中治疗组73例,对照组72例。治疗纽给予阿莫西林克拉维酸钾联合阿奇霉素治疗,对照组只单纯给予应用阿莫西林克拉维酸钾。两组疗程均为7～14d。于治疗后比较两组的临床疗效。结果：（1）治疗组治愈、显效、有效、无效分别为43例（58．9％）、16例（21．9％）、8例（11．0％）、6例（8．2％）;对照组分别为20例（27．8％）、26例（36．1％）、14例（19．4％）、12例（16．7％）。两组疗效比较,差异有统计学意义（P〈0．05）。（2）治疗组胃肠道反应、静脉滴注局部疼痛、皮疹的发生分别为6例（8．2％）、7例（9．6％）、3例（4．1％）,总不良反应发生率为16例（21．9％）;对照组分别为5例（6．9％）、6例（8.3％）、3例（4．2％）、14例（19．4％）。两组不良反应发生率比较,差异无统计学意义（P〉0．05）。结论：阿莫西林克拉维酸钾联合阿奇霉素治疗CAP疗效好。     

儿童社区获得性支原体肺炎病原学与影像学特征分析

目的:回顾性分析我院儿童社区获得性肺炎(Community-acquired pneumonia,CAP)患儿病原学检测结果,为本地区CAP患儿的临床治疗提供参考依据。方法:选取2014年5月-2018年5月812例符合中华医学会儿科学分会制定的儿童社区获得性肺炎(2013修订)诊断标准的CAP患儿,分析患儿的临床特征及影像学检查结果,并进行分析。结果:非重症CAP患儿812例,CAP占10.2%;感染病原体例数481例,阳性检出率为59.2%;1月-1岁龄组与1-5岁龄组比较差异无统计学意义(P0.05);5-14岁龄组发热发生率明显高于前两组,差异均有统计学意义(P0.05)。咳嗽、喘息、固定湿啰音发生率集中在1月-1岁龄组与1-5岁龄组,且高于5-14岁龄组发生率(P0.0);肺部影像学改变的患儿共657例,占80.9%。三个年龄组;肺部影像学改变差异有统计学意义(P0.05)。结论:不同年龄段CAP患儿病原体检出率不同;不同年龄和不同病原学感染的儿童CAP的影像学表现各有特点,对于临床医生早发现、早诊断、早治疗具有一点的指导性意义。     

A comparison between sequential therapy and a modified bismuth-based quadruple therapy for Helicobacter pylori eradication in Iran: a randomized clinical trial

Background: Sequential regimens have been recently reported to be superior to the standard triple therapies in Helicobacter pylori eradication, but most of these studies were performed in Europe and data from developing countries are lacking. So we designed a study to compare a sequential regimen with a bismuth‐based quadruple therapy that contains a short course of furazolidone, in Iran. Methods: Two hundred and ninety‐six patients with duodenal ulcer and naïve H. pylori infection were randomized into two groups: 148 patients received (PAB‐F) pantoprazole (40 mg‐bid), amoxicillin (1 g‐bid), and bismuth subcitrate (240 mg‐bid) for 2 weeks and furazolidone (200 mg‐bid) just during the first week. And 148 patients received (PA‐CT) pantoprazole (40 mg‐bid) for 10 days, amoxicillin (1 g‐bid) for the first 5 days, and clarithromycin (500 mg‐bid) plus tinidazole (500 mg‐bid) just during the second 5 days. C¹⁴‐urea breath test was performed 8 weeks after the treatment. Results: Two hundred and sixty‐one patients completed the study (137 patients in the PA‐CT and 124 in the PAB‐F group). The results were not statistically different between the two groups in the eradication rates and the severity of side effects. The intention to treat eradication rate was 80.4% in the PAB‐F group and 83.7% in the PA‐CT group. Per‐protocol eradication rates were 88.7% and 89.1%, respectively. Conclusion: Because the two regimens showed acceptable and similar abilities in H. pylori eradication and because of much higher cost of clarithromycin in Iran, the furazolidone containing regimen seems to be superior. Further modifications of sequential therapies are needed to make them ideal regimens in developing countries.     

Microbiological evaluation of antibiotics for empirical therapy of community-acquired infections of the lower respiratory tract]

During first 3 days after patient hospitalization with pneumonia or chronic obstruction pulmonary disease (COPD) pathogens in sputum were studied according NCCLS standards (for 1999 year). Among 93 pathogens isolated in pneumonia the most frequent were S. pneumoniae (41.9%), H. influenzae (21.5%). Among 232 pathogens isolated in COPD the most frequent were S. pneumoniae (35.5%), H. influenzae (16.8%). Other pathogens were staphylococci, moraxella, gram-negative bacteria. No penicillin-resistant S. pneumoniae, were isolated, the strains with moderate penicillin resistance were less than 3% in both groups. Among H. influenzae isolated from patients with pneumonia 25% were beta-lactamase producers, from COPD patients 21% strains produced beta-lactamase. Totally among all studied pathogens only 58% were sensitive to ampicillin in pneumonia groups and 48% in COPD groups, for azithromycin 70.7% and 71% respectively, for cefuroxime 84.5% and 85% respectively. Ampicillin efficacy for empirical treatment of community-acquired low respiratory tract infections was substantially less than that of modern antibiotics.     

中性粒细胞与淋巴细胞比值在急诊老年社区获得性肺炎中的应用价值

目的:探讨中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte rate,NLR)在急诊老年社区获得性肺炎(community acquired pneumonia,CAP)患者中的应用价值。方法:选择2018年10月到2019年10月首都医科大学宣武医院急诊观察室收治的130例老年CAP患者,检测其入院后血常规,血清C反应蛋白(C-reactive protein,CRP)、降钙素原(Procalcitonin,PCT)水平,血气分析,生化全项,胸部X线,并给予痰细菌学检查等辅助检查,进行急性生理及慢性健康状况评分(Acute Physiology and Chronic Health Evaluation,APACHEⅡ)。入院72h后,再次给予血常规、PCT等检查,比较2组NLR和PCT的差异。随访28天后,根据老年CAP患者的临床转归分成死亡组和生存组,比较2组白细胞(WBC)、NLR、CRP、APACHEⅡ评分和PCT及NLR、PCT、APACHEⅡ预测老年CAP患者死亡的ROC曲线下面积(AUC)。结果:死亡组CAP患者血清CRP、PCT水平、NLR和APACHEⅡ评分均显著高于生存组(P<0.05),2组患者WBC比较差异无明显统计学意义(P=0.341)。APACHE II评分预测老年CAP患者死亡的AUC为0.741(95%CI:0.647~0.836),PCT预测老年CAP患者死亡的AUC为0.723(95%CI:0.610~0.835),NLR预测老年CAP患者死亡的AUC为0.709 (95%CI:0.602~0.815),NLR预测老年CAP患者死亡的AUC与PCT和APACHE II评分比较无统计学差异(P=0.848,0.662);入院72h死亡组NLR和PCT入院时无明显变化(P>0.05),而生存组NLR和PCT较入院时比较显著降低(P<0.01)。结论:NLR对急诊老年CAP患者的预后预测价值与PCT及APACHE II评分相当,NLR持续高水平状态提示急诊老年CAP患者的预后不良。     

复合型抗菌药联合阿奇霉素对大叶性肺炎炎性指标的影响

目的:头孢哌酮钠舒巴坦钠与阿奇霉素联合应用对大叶性肺炎病人体内TNF-α、IL-6及HMGB1的变化影响及其临床疗效研究。方法:收集2012年11月至2015年3月期间到笔者所在医院就诊并诊断患有大叶性肺炎的病人随机平分成两组,其中A组与B组成员分别使用头孢哌酮钠舒巴坦钠+阿奇霉素和仅使用阿奇霉素进行大叶性肺炎对症治疗。通过炎性指标变化情况及对肺功能、不良反应的观察,分析两种药物联合应用对大叶性肺炎病人体内TNF-α、IL-6及HMGB1的变化影响和临床应用价值。结果:A组经联合用药治疗后相关炎症指标改善情况普遍优于B组;A组大叶性肺炎病人咳嗽、啰音及相关体征表现恢复速度快于B组,且A组病人在联合药物治疗后FEF和FEF50指标上的改善情况更为突出;而A组病人不良反应发生种类及例数、比率与B组却相差不大(P0.05)。结论:头孢哌酮钠舒巴坦钠与阿奇霉素的联合应用可有效降低病人体内TNF-α、IL-6及HMGB1浓度水平,且其治疗效果较为突出,具有一定的应用价值。     

Clinical applications of azithromycin microspheres in respiratory tract infections

Few adequately designed clinical trials have addressed optimal treatment duration in lower respiratory tract infections. Drugs possessing favourable pharmacokinetic and pharmacodynamic profiles may obtain early bacterial eradication allowing shorter treatment duration. This may be associated with a number of advantages including reduced resistance induction, increased compliance, lesser adverse events, and cost containment. Recently, a novel 2.0 g single dose of azithromycin microspheres has been compared with 7-day levofloxacin 500 mg or extended release clarithromycin in over 400 patients with community-acquired pneumonia. Clinical cure and bacteriological eradication rates, hospitalizations, and deaths were similar between azithromycin and comparators. Azithromycin 2.0 g microspheres proved as effective as 7 days of levofloxacin 500 mg in acute exacerbation of chronic bronchitis patients across all degrees of obstruction severity. In both settings Azithromycin microspheres obtained clinical cure in most patients harbouring macrolide-resistant Streptococcus pneumoniae strains. The drug was well tolerated in clinical studies and in healthy volunteers with modest and transitory adverse events. An undoubted advantage of single-dose azithromycin administration is the facility in ensuring that patients complete their prescribed course of therapy. A further advantage of single-dose therapy is the potential for use as directly-observed therapy, which may be useful in specific clinical conditions.