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      关于对于左氧氟沙星在耐多药肺结核治疗中的效果观察网站位置: >> 医药学论文 >> 药剂学论文 >> 浏览文章
      对于左氧氟沙星在耐多药肺结核治疗中的效果观察

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      左氧氟沙星在耐多药肺结核治疗中的效果观察【摘要】目的:了解左氧氟沙星在耐多药肺结核临床治疗中的效果,观察其不良反应和安全性。策略:对2013年4月到2014年4月接诊的74例耐多药肺结核患者进行临床治疗比较观察。对照组37人接受常规药物治疗。实验组37人在对照组的基础上酌情添加左氧氟沙星,比较观察两组患者的康复效果、不良反应等情况。结果:实验组显效14例、好转21例、无效2例,康复率为94.5%;对照组显效9例、好转22例、无效6例,有效率为83.7%。两组康复效果存在明显差异,p<0.05。实验组发生转氨酶升高3例、肠胃不适2例,头晕4例;对照组出现转氨酶升高6例、肠胃不适5例、头晕恶心5例。结论:左氧氟沙星在耐多药肺结核临床治疗中表现出色,具有临床推广意义。
        【关键词】耐多药肺结核;左氧氟沙星;效果观察
        1004-4949(2014)09-0273-02
        耐多药肺结核是致死率较高的一类疾病,具有发病广泛、病情迁延难治、耐药性强的特征,给患者的生命健康和安全带来巨大威胁。临床治疗发现常用的利福平、异烟肼等药物效果不佳。本次研究采用新型广谱抗菌药物左氧氟沙星进行治疗,发现患者的康复效果比使用常规药物有较明显的提高,现在报告如下。
        1资料与策略
        1.1基本资料 选择2013年4月到2014年4月接诊的74例耐多药肺结核患者进行临床治疗观察。对照组37人,其中男性17人、女性20人,年龄为21~78岁,平均年龄42.6±3.5岁,侵润型14例、空洞型23例。实验组37人,其中男性19人,女性18人,年龄为23~74岁,平均年龄43.2±3.1岁,侵润型17人,空洞型17例。两组患者的年龄、病情、性别不存在明显差异,p>0.05,有可比性。对于存在肝肾功能障碍、心脑血管疾病、精神类疾病或喹诺酮类药物过敏病史的患者进行排除。
        1.2治疗策略 对照组采用常规治疗。每日肌注阿米卡星0.4g一次,口服丙硫异烟胺片0.2g两次,口服氨基水杨酸钠4g三次。实验组在对照组的基础上给与左氧氟沙星0.2~0.3g,每天两次[1]。治疗期间认真观察记录患者的痰细菌学表现、肺部造影、肝肾功能、血常规、尿常规等项目,对患者接受治疗后的不良反应情况进行登记。
        1.3评价标准 根据《结核病诊疗指南》[2]对患者的痰细菌学检查结果进行判断,持续两个月转阴为有效。根据胸片检查判断病灶部位康复状况,以吸收超过2/3且空洞闭合为显效。以吸收不足2/3且空洞缩小为好转。以病灶、空洞无变化甚至恶化为无效。
        1.4统计学处理 采用SPSS16.0软件进行统计学处理,以t进行检验,以p<0.05为差异有统计学意义。
        2结果
        2.1实验组和对照组的康复效果分析 实验组显效14例、好转21例、无效2例,康复率为94.5%;对照组显效9例、好转22例、无效6例,有效率为83.7%。两组康复效果存在明显差异,p<0.05,详见表1.
        3讨论
        耐多药肺结核是指肺结核患者对异烟肼、利福平等多种肺结核药物有较强的耐药性。此类患者接受治疗的效果普遍不理想,多具有久治不愈、效果不明显的特征,成为当前威胁人类健康的呼吸系统主要疾病之一。从表1的结果来看,实验组在常规治疗方式上加入左氧氟沙星的效果较为理想,患者的康复效率达到94.5%,远高于常规治疗组的83.7%。结合实验组和对照组不良反应的发生情况来看,左氧氟沙星显然具有康复效果好、不良反应少、适用范围广的特点。根据相关文献报道给出的结论,左氧氟沙星能够起到抑制细菌复制转录的效果[3],它在与R、H等药物进行搭配使用的时候不但没有产生交叉耐药性,还能够增强抗菌能力,提升药物的杀伤力,降低患者的耐药性。左氧氟沙星是一种典型的喹诺酮类药物,根据药代动力学的相关研究,喹诺酮类药物的生物利用率很高,服药后药物在体液中的浓度与血药浓度之比≥1.0,对结核细菌的杀灭效果优于常规药物。
        对于利福平、丙硫异烟胺德国药物治疗肺结核效果不理想的理由,我们分析与医务人员治疗肺结核的过程中用药不当有直接关系[4]。肺结核临床治疗中多见多种药物的混合使用,而在药物用量、搭配比例、服药频率方面却并没有做到科学合理,这就造成患者容易产生较强的耐药性,导致肺结核治疗无效。本次研究中所采用的左氧氟沙星不产生交叉耐药性,杀灭结核细菌的效率倍增,自然可以起效更快、效果更好。
        至于在本次研究中发现实验组有转氨酶升高、头晕、肠胃不适等5例不良反应,这与相关研究中阐述左氧氟沙星易发生胃肠道不适、神经系统不适、血尿癫痫、过敏等不良反应的观点相一致,同时也验证了左氧氟沙星产生不良反应更少的观点[5]。
        4结论
        左氧氟沙星治疗耐多药肺结核的效果较为理想,不良反应较少,具有临床推广价值。
        参考文献
        [1] 马燕妮.莫西沙星与左氧氟沙星治疗耐多药肺结核的临床效果观察.[J].中国当代医药,2014年,第8期.
        [2] 谢梅 王芳.左氧氟沙星治疗耐多药肺结核疗效与安全性的系统评价.[J].吉林医学,2014年,第12期.
        [3] 李桂琴.耐多药肺结核治疗的疗效分析30例.[J].中国社区医师:医学专业,2012年,第2期.
        [4] 张霞 张丽 马斌等.左氧氟沙星治疗耐多药肺结核的疗效及不良反应.[J].中外女性健康,2013年,第06X期.
        [5] 王经林.左氧氟沙星辅治耐多药肺结核的疗效和安全性分析.[J].临床合理用药杂志,2013年,第19期. 全文地址:http://www.abcanuncios.com/yjxlw/lw50504.html
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