多黏菌素B雾化吸入在机械通气重症肺炎患者中的有效性和安全性

杨依磊; 张虎; 曹佳; 衣巧艳; 黄欣; 李妍; 杨蕊

doi:10.6039/j.issn.1001-0408.2023.19.14

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多黏菌素B雾化吸入在机械通气重症肺炎患者中的有效性和安全性

药物与临床 | 更新时间：2023-10-09

- 多黏菌素B雾化吸入在机械通气重症肺炎患者中的有效性和安全性
- Efficacy and safety of aerosol inhalation of polycolistin B in patients with severe pneumonia combined with mechanical ventilation
- 中国药房 2023年34卷第19期页码：2385-2390
- 作者机构：
  
  1.山东第一医科大学第一附属医院（山东省千佛山医院）临床药学科，山东省儿童药物临床评价与研发工程技术研究中心，山东省医药卫生临床药学重点实验室，济南　250014
  2.山东第一医科大学第一附属医院（山东省千佛山医院）健康医疗大数据研究中心，济南　250014
- 作者简介：
  
  主管药师，博士。研究方向：临床药学。电话：0531-89268352。E-mail：yileiyang@126.com
  副主任药师，硕士生导师，博士。研究方向：临床药学。电话：0531-89268352。E-mail：yxyyr@163.com
- 基金信息：
- DOI：10.6039/j.issn.1001-0408.2023.19.14
  中图分类号： R969.4
- 纸质出版日期：2023-10-15，
  
  收稿日期：2023-05-06，
  
  修回日期：2023-09-12，
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杨依磊,张虎,曹佳等.多黏菌素B雾化吸入在机械通气重症肺炎患者中的有效性和安全性^Δ[J].中国药房,2023,34(19):2385-2390.

YANG Yilei,ZHANG Hu,CAO Jia,et al.Efficacy and safety of aerosol inhalation of polycolistin B in patients with severe pneumonia combined with mechanical ventilation[J].ZHONGGUO YAOFANG,2023,34(19):2385-2390.
杨依磊,张虎,曹佳等.多黏菌素B雾化吸入在机械通气重症肺炎患者中的有效性和安全性^Δ[J].中国药房,2023,34(19):2385-2390. DOI： 10.6039/j.issn.1001-0408.2023.19.14.

YANG Yilei,ZHANG Hu,CAO Jia,et al.Efficacy and safety of aerosol inhalation of polycolistin B in patients with severe pneumonia combined with mechanical ventilation[J].ZHONGGUO YAOFANG,2023,34(19):2385-2390. DOI： 10.6039/j.issn.1001-0408.2023.19.14.

摘要

目的

探讨多黏菌素B雾化吸入联合静脉滴注在治疗机械通气重症肺炎患者中的有效性和安全性，为临床治疗提供真实世界参考数据。

方法

采用回顾性队列研究方法，分析2021年1月至2023年2月山东第一医科大学第一附属医院的87例机械通气重症肺炎患者的临床资料。所有患者根据给药途径不同分为联合组（24例，采用多黏菌素B雾化吸入联合静脉滴注）和常规组（63例，采用多黏菌素B单独静脉滴注），比较两组患者在有效性（死亡率、临床有效率和细菌清除率）和安全性（血肌酐升高、支气管痉挛和皮肤色素沉着）方面的差异；并采用单因素分析和多因素Logistic回归分析对主要结局指标死亡率的影响因素进行分析。

结果

在有效性方面，两组患者在死亡率（37.50% vs. 41.27%，

＝0.749）、临床有效率（54.17% vs. 55.56%，

＝0.907）和细菌清除率（45.83% vs. 44.44%，

＝0.907）方面的差异均无统计学意义。在安全性方面，联合组患者的支气管痉挛发生率显著高于常规组（12.50% vs. 0，

＝0.028），而两组间血肌酐升高和皮肤色素沉着发生率的差异均无统计学意义（

＞0.05）。单因素分析显示，感染鲍曼不动杆菌、感染肺炎克雷伯菌以及联用喹诺酮类药物的机械通气重症肺炎患者死亡率较高（

＜0.05）；多因素Logistic回归分析显示，感染鲍曼不动杆菌（OR＝3.36，

＝0.014）和联用喹诺酮类药物（OR＝3.54，

＝0.013）与死亡率独立相关（

＜0.05）。

结论

对于机械通气重症肺炎患者，多黏菌素B静脉滴注联合雾化吸入较单独静脉滴注并未显示出更加优越的有效性，反而支气管痉挛的发生率显著提高。感染鲍曼不动杆菌与联用喹诺酮类药物是该类患者死亡率提高的独立危险因素。

Abstract

OBJECTIVE

To investigate the efficacy and safety of aerosol inhalation of polycolistin B in the treatment of severe pneumonia combined with mechanical ventilation， and to provide a reference of real-world data for clinical drug therapy.

METHODS

A retrospective cohort study was conducted to analyze the clinical data of 87 patients with severe pneumonia combined with mechanical ventilation at the First Affiliated Hospital of Shandong First Medical University from January 2021 to February 2023. According to route of administration， all patients were divided into combined group （24 cases， receiving aerosol inhibition of polycolistin B combined with intravenous dripping） and routine group （63 cases， intravenous dripping of polycolistin B alone）. The differences in efficacy （mortality， clinical response rate and bacterial clearance rate）and safety（elevated serum creatinine， bronchospasm and skin pigmentation） were compared between two groups； the influential factors of primary outcome index as mortality were analyzed through univariate analysis and multivariate Logistic regression analysis.

RESULTS

In terms of efficacy， there were no statistical differences in mortality（37.50% vs. 41.27%，

＝0.749）， clinical response rate （54.17% vs. 55.56%，

＝0.907） and bacterial clearance rate （45.83% vs. 44.44%，

＝0.907） between the two groups. In terms of safety， the incidence of bronchospasm in the combined group was significantly higher than that of the routine group（12.50% vs. 0，

＝0.028）， but the differences in incidence of elevated serum creatinine and skin pigmentation between two groups were not statistically significant （

＞0.05）. Univariate analysis showed that the moralities were higher in the case of infected with

Acinetobacter baumannii

，

Klebsiella pneumoniae

and combined use of quinolones （

＜0.05）； multivariate Logistic regression analysis showed that infection with

A. baumannii

（OR＝3.36，

＝0.014） and combined use of quinolones （OR＝3.54，

＝0.013） were independently associated with mortality （

＜0.05）.

CONCLUSIONS

For severe pneumonia patients with mechanical ventilation， intravenous dripping of polycolistin B combined with aerosol inhalation does not show superior efficacy compared with intravenous dipping of polycolistin B alone， but significantly increases the incidence of bronchospasm. Infection with

A. baumannii

and combined use of quinolones are independent risk factors for the increase of mortality.

关键词

多黏菌素B雾化吸入重症肺炎机械通气有效性安全性

Keywords

aerosol inhalationsevere pneumoniamechanical ventilationefficacysafety

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