摘要目的 观察利奈唑胺经验治疗耐甲氧西林葡萄球菌(MRS)肺炎的临床效果及安全性.方法 采用回顺性队列研究,收集山东省滨州市人民医院2009年3月-2010年10月使用利奈唑胺治疗MRS肺炎的住院患者135例,将患者分为经验治疗组(75例),即入院后立即应用利奈唑胺0.6 g,静脉滴注,1次/12 h;目标治疗组(60例),待细菌培养确定为MRS感染后再选用利奈唑胺治疗.观察治疗后的病情评分、临床疗效及不良反应,并重点评价高危肺炎患者的治疗效果.采用SPSS 13.0软件进行统计学分析.结果 经验治疗组和目标治疗组治疗3 d和7 d后病情评分较治疗前均显著下降(t经验治疗=12.29和16.53,t目标治疗=9.36和11.49,P值均<0.05),且组间比较差异也有统计学意义(t=2.64和3.08,P值均<0.01).经验治疗组在肺炎吸收时间、ICU住院天数及总的住院天数方面与目标治疗组相比,差异具有统计学意义(t=6.61、4.39和10.25,P值均<0.05).两组临床有效率分别为88.0%(66/75)和83.3%(50/60)(x2=0.60,P>0.05).对于高危人群肺炎患者,治疗后两组临床有效率分别为86.8%(33/38)和63.6%(14/22),差异有统计学意义(X2=4.42,P<0.05).经验治疗组不良反应发生率为6.7%(5/75),目标治疗组为5.0%(3/60),差异无统计学意义(x2=0.17,P>0.05).结论 利奈唑胺作为MRS所致肺炎的经验用药能较快缓解症状,临床有效率高,尤其针对高危人群肺炎患者,疗效确切,安全性较好.

abstractsObjective To evaluate the efficacy and safety of linezolid in empirical treatment of methicillin-resistant Staphylococcus (MRS) pneumonia. Methods One hundred and thirty-five hospitalized patients with MSR pneumonia receiving linezolid from April 2009 to October 2010 were enrolled in this retrospective cohort study, and all subjects were assigned to two groups: 75 cases with empirical treatment (linezolid 0. 6 g by infusion q12h at admission) , and 60 cases with objective treatment (linezolid after the sputum culture). The severity score, clinical effect and adverse effect were observed, and the therapeutic effects in patients with high risk factors were especially evaluated. SPSS13.0 software was used for statistical analysis. Results The scores were decreased significantly after finishing therapeutic causes for 3 and 7 days in both groups (tempirical =12.29 and 16.53, tobjective =9.36 and 11.49, P<0. 05). There were significant differences in severity scores after 3 and 7 days between empirical and objective treatment groups (t =2. 64 and 3. 08, P < 0. 01). There were significant differences in absorption time, length of ICU and total hospital stay between two groups (t =6. 61 , 4. 39 and 10. 25, P <0. 05). In empirical and objective group, the effective rates were 88.0% (66/75) and 83.3% (50/60) (x2 = 0.60, P > 0.05 ). In the patients with high risk factors, the effective rates of two groups were 86. 8% (33/38) and 63. 6% (14/22) , and the difference was significant (x2 =4.42, P<0.05). The rate of adverse effects were 6.7% (5/75) in empirical group and 5.0% (3/60) in objective group, and the difference was not significant (x2 =0. 17, P > 0. 05). Conclusion Linezolid can be used as empirical treatment for MRS pneumonia with rapid symptoms relieve and high efficacy, especially for patients with high risk.