摘要目的：评价替加环素治疗呼吸机相关性肺炎（VAP）老年危重症患者的临床疗效。方法回顾性分析2011年6月至2014年3月浙江医院重症医学科应用替加环素治疗VAP老年危重症患者的病例资料，对其临床疗效进行评价。结果纳入79例患者（男83．5％），平均年龄84（65～100）岁。感染常见的致病菌为鲍曼不动杆菌（39．1％）、铜绿假单胞菌（35．0％）和肺炎克雷伯菌（23．8％）。所有患者均接受替加环素治疗，其中54．4％的患者联合其他抗菌药物，35．4％为加倍剂量应用，抗生素应用的平均时间为9（2～22） d。治疗结束后，临床成功44例（55．7％），临床失败29例（36．7％），临床不确定6例（7．6％）。治疗结束28 d后，患者总体病死率为39．0％。亚组分析表明，临床成功率与APACHEⅡ评分是否＜15相关（ APACHEⅡ＜15与APACHEⅡ≥15的临床成功率分别为72．2％和41．9％，P＝0．007），同时比较差异有统计学意义的包括替加环素是否使用加倍剂量（71．4％比47．1％，P＝0．037），以及是否联合应用其他抗菌药物（67．4％比41．7％，P＝0．022）。结论替加环素治疗VAP的老年危重症患者联合用药或使用加倍剂量均可改善临床疗效。

abstractsObjective To evaluate the efficacy of tigecycline for treatment of ventilator-associated pneumonia in critically ill elderly patients.Methods Data of critically ill elderly patients with ventilator-associated pneumonia treated with tigecycline in the intensive care unit was collected from June 2011 to March 2014 in this retrospective study, to evaluated the clinical efficacy of tigecycline.Results A total of 79 patients (83.5%male) were included, the mean age was 84 years old (rang, 65 years to 100 years old). Acinetobacter baumannii ( 39.1%) , Pseudomonas aeruginosa ( 35.0%) and Klebsiella pneumonia (23.8%) were the most common pathogens.All patients were treated with tigecycline, 54.4% combined with other antimicrobial agents, 35.4% treated with double dose of tigecycline, and the mean course of antibiotic treatment was 9 days (range, 2 days to 22 days).After treatment, clinical success were recorded in 44 patients (55.7%), clinical failure were recorded in 29 patients, clinical uncertainty were recorded in 6 patients.28 days after treatment, patients′overall mortality was 39.0%.The clinical success rates were associated with acute physiology and chronic health evaluation ( APACHE ) Ⅱ score less than 15 ( the clinical success rates were 72.2% and 41.9% in patients with APACHE Ⅱ score<15 and APACHE Ⅱscore≥15, respectively; P=0.007); treated with double dose of tigecycline (71.4% vs 47.1%, P=0.037) or combination regimens were also had significant difference (67.4%vs 41.7%, P=0.022). Conclusions Treatment of tigecycline combined with other antimicrobial agents and double dose of tigecycline may both can improve clinical efficacy in critically ill elderly patients with ventilator-associated pneumonia.