Effect of Cefoperazone / Sulbactam combined with bedside bronchoscopy lavage in the treatment of aspiration pneumonia after stroke#br#
HAO Xingliang1 JI Yanrong1 ZHANG Jian1 WANG Naizhi1 LI Shuang1 WANG Yingying2
1.Department of Respiratory and Critical Care Medicine, Shengli Oilfield Central Hospital, Shandong Province, Dongying 257034, China;
2.Department of Pharmacy Clinical Pharmacy, Shengli Oilfield Central Hospital, Shandong Province, Dongying 257034, China
Abstract：Objective To investigate the effect of Cefoperazone/Sulbactam combined with bedside bronchoscopy lavage in the treatment of aspiration pneumonia after stroke. Methods A total of 98 patients with secondary aspiration pneumonia after stroke admitted to Shengli Oilfield Central Hospital of Shandong Province from June 2019 to June 2020 were selected. According to the diagnosis and treatment process, the patients were divided into Cefoperazone / Sulbactam treatment group (group A, 48 cases) and Cefoperazone and Sulbactam combined with bedside bronchoscopy treatment group (group B, 50 cases). Group A was given Cefoperazone / Sulbactam to fight infection on the basis of routine treatment. Group B was given bedside portable bronchoscopy and lavage on the basic of routine treatment and Cefoperazone/Sulbactam anti-infection treatment. Blood gas analysis indexes, white blood cell (WBC) count, procalcitonin (PCT), chest film and clearance rate of pathogenic bacteria were compared between the two groups before and after seven days of treatment. The temperature recovery time, antibiotic application time, hospital stay time and treatment effect were compared between the two groups after seven days of treatment. Results After after seven days of treatment, the arterial partial pressure of oxygen (PaO2) level in the two groups was increased compared with that before treatment, and the arterial partial pressure of carbon dioxide (PaCO2), WBC, and PCT levels were decreased compared with before treatment (P ＜ 0.05). The levels of PaO2 in group B were higher than those in group A, while the levels of PaCO2, WBC, and PCT were lower than those in group A (P ＜ 0.05). The results of chest radiography in group B were better than that in group A (P ＜ 0.05). The clearance rate of pathogenic bacteria in group B was higher than that in group A (P ＜ 0.05). Body temperature recovery time, antibiotic application time, and hospital stay time in group B were shorter than those in group A (P ＜ 0.05). After after seven days of treatment, the total effective rate of group B was higher than that of group A (P ＜ 0.05). Conclusion Cefoperazone / Sulbactam combined with bedside bronchoscopy lavage is beneficial to clearing airway secretions, improving clinical symptoms, and improving the isolation and removal of pathogenic bacteria, which is worthy of promotion in inhalation pneumonia.
郝兴亮1 纪艳荣1 张建1 王乃志1 李霜1 王莹莹2. 头孢哌酮/舒巴坦联合床旁支气管镜灌洗治疗脑卒中后吸入性肺炎的效果[J]. 中国医药导报, 2022, 19(8): 117-120,125.
HAO Xingliang1 JI Yanrong1 ZHANG Jian1 WANG Naizhi1 LI Shuang1 WANG Yingying2. Effect of Cefoperazone / Sulbactam combined with bedside bronchoscopy lavage in the treatment of aspiration pneumonia after stroke#br#. 中国医药导报, 2022, 19(8): 117-120,125.
[1] Neill S，Dean N. Aspiration pneumonia and pneumonitis：a spectrum of infectious /noninfectious diseases affecting the lung [J]. Curr Opin Infect Dis，2019，32（2）：152-157. DOI：10.1097/QCO.0000000000000524.
[2] 中国吞咽障碍康复评估与治疗专家共识组.中国吞咽障碍评估与治疗专家共识（2017年版）第一部分评估篇[J].中华物理医学与康复杂志，2017，39（12）：881-892. DOI：10.3760/cma.j.issn 0254-1424.2017.12.001.
[3] Mandell LA，Niederman MS. Aspiration pneumonia [J]. N Engl J Med，2019，380（7）：651-663. DOI：10.1056/NEJMra1714562.
[4] Wu CP，Chen YW，Wang MJ，et al. National trends in admission for aspiration pneumonia in the United States，2002-2012 [J]. Ann Am Thorac Soc，2017，14（6）：874-879. DOI：10.1513 /AnnalsATS.201611-867OC.
[5] Hayashi M，Iwasaki T，Yamazaki Y，et al. Clinical features and outcomes of aspiration pneumonia compared with non-aspiration pneumonia：a retrospective cohort study [J]. J Infect Chemother，2014，20（7）：436-442. DOI：10.1016/j.jiac.2014.04.002.
[6] 贾建平.神经病学[M].7版.北京：人民卫生出版社，2008：267.
[7] 方荣，施荣，欧阳洋，等.老年吸入性肺炎的诊治策略[J].中国急救医学，2016，36（2）：126-129.
[8] 周淑华，徐秀萍，毛芝芳，等.左氧氟沙星与氨溴索联合治疗对慢性阻塞性肺疾病合并肺部感染老年患者的疗效研究[J].中华医院感染学杂志，2018，28（6）：848-851.
[9] 宁璞，杨菁菁，孙铁英，等.住院老年人吸入性肺炎患病率及其危险因素分析[J].中华老年医学杂志，2017，36（4）：428-432.
[10] Sura L，Madhavan A，Carnaby G，et al. Dysphagia in the elderly：management and nutritional considerations [J]．Clin Interv Aging，2012，27（7）：287-298． DOI：lO.2147/ CIA.S23404.
[11] Ouyang M，Boaden E，Arima H，et al. Dysphagia screening and risks of pneumonia and adverse outcomes after acute stroke：an international multicenter study [J]. Int JStroke，2020，15（2）：206-215.
[12] Pacheco-Castilho AC，Vanin GM，Dantas RO，et al. Dysphagia and associated pneumonia in stroke patients from Brazil：a systematic review [J]. Dysphagia，2019，34（4）：499-520.
[13] 孙敏敏.老年脑卒中合并吸入性肺炎临床特征观察[J].临床肺科杂志，2017，22（1）：168-170.
[14] 龙云霞，陈波，姜利琼.老年人吸入性肺炎与非吸入性肺炎的临床特征及肺功能比较[J].河北医药，2020，42（11）：1649-1652. DOI：10.3969/j.issn.1002-7386.2020. 11.011.
[15] Hannawi Y，Hannawi B，Rao CP，et al. Stroke-associated pneumonia：major advances and obstacles [J]. Cerebrovasc Dis，2013，35（5）：430-443.
[16] 熊玮，曾玉兰，杨荣时.老年吸入性肺炎病原学及临床分析[J].临床内科杂志，2016，33（8）：560-562.
[17] 中国卒中学会急救医学分会，中华医学会急诊医学分会卒中学组，中国老年医学学会急诊医学分会，等.卒中相关性肺炎诊治中国专家共识（2019更新版）[J].中国急救医学杂志，2019，39（12）：1135-1143. DOI：10. 3969/j.issn.1002-1949.2019.12.002.
[18] 李泰阶，郭世辉，李萌，等.临床分离革兰阴性杆菌对头孢哌酮-舒巴坦、亚胺培南、美罗培南和阿米卡星的耐药性变迁[J].中国感染与化疗杂志，2015，15（5）：462-465.
[19] Karlowsky JA，Walkty AJ，Adam HJ，et al. Prevalence of antimicrobial resistance among clinical isolates of Bacteroides fragilis group in Canada in 2010-2011：CANWARD surveillance study [J]. Antimicrob Agents Chemother 2012，56（3）：1247-1252.
[20] Snydman DR，Jacobus NV，McDermott LA，et al. National survey on the susceptibility of Bacteroides fragilis group： report and analysis of trends in the United States from 1997 to 2004 [J]. Antimicrob Agents Chemother 2007， 51（5）：1649-1655.
[21] 李刚，张素巧，张国强，等.纤维支气管镜下生理盐水灌洗在重症吸入性肺炎患者中的应用[J].临床药物治疗杂志，2019，17（3）：21-24.
[22] 刘柏容，徐志灯，谢丹.经纤维支气管镜肺泡灌洗治疗吸入性肺炎的疗效观察[J].齐齐哈尔医学院学报，2020， 41（10）：1230-1232.
[23] 悦云.纤维支气管镜对机械通气治疗COPD并呼吸衰竭的效果及并发症的影响[J].中国急救医学，2015，35（4）：355-358.
[24] 陈进永，吴志元，庞郁炬，等.纤维支气管镜肺泡灌洗联合局部抗生素治疗机械通气卒中相关性肺炎的效果观察[J].中国医药科学，2021，11（11）：194-197.
[25] 黄明，张冬，董文玲，等.床旁纤维支气管镜治疗在危重患者急性肺不张中的临床价值[J].国际呼吸杂志，2015， 35（21）：1641-1644.
[26] 韩秋，李靖，沈军，等.床旁纤维支气管镜辅助治疗卒中相关性肺炎的疗效[J].中华实验和临床感染病杂志：电子版，2016，10（3）：323-326.
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