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目的:探讨老年脑梗死合并肺感染患者的抗感染药物的临床合理使用。方法:采用回顾性调查方法,对宣武医院神经内科临床药师2013年2月~2015年11月会诊的86例老年脑梗死合并肺感染患者的抗感染用药情况进行分析。结果:患者肺部感染主要致病菌为鲍曼不动杆菌及铜绿假单胞菌,耐药率达48.89%;会诊后联合用药比例由20.23%升至61.63%;患者经头孢哌酮/舒巴坦、哌拉西林/舒巴坦及阿米卡星等敏感抗菌药足量治疗后感染指标较会诊前明显恢复(P<0.05)。27例合并肾功不全病例中有17例(62.9%)尿素氮肌酐比值>20,患者抗菌药未减量,但感染指标与肾功能均有好转(P<0.05)。45例(53.49%)患者合并低蛋白血症,会诊后感染指标均有所下降,蛋白水平有所升高(P<0.05)。结论::脑梗死合并肺部感染的老年患者应选择耐药率低的敏感抗菌药单药或联合应用;合并肾功能不全的患者要明确肾衰性质,适当调整抗菌药用量;合并营养不良的患者,及时增加蛋白的摄入可促进感染的控制。老年脑梗死合并肺部感染的患者应结合临床症状及实验室指标,合理制定抗感染药物治疗方案。
Objective: To investigate the clinical rational use of anti-infectives in elderly patients with cerebral infarction and pulmonary infection. Methods: The retrospective investigation method was used to analyze the anti-infective medication of 86 elderly patients with cerebral infarction complicated with lung infection who were interviewed by the clinical pharmacist of Xuanwu Hospital from February 2013 to November 2015. Results: The main pathogens of pulmonary infection in patients with Acinetobacter baumannii and Pseudomonas aeruginosa, the drug resistance rate of 48.89%; consultation after the combination of drug rose from 20.23% to 61.63%; patients with cefoperazone / Bactan, piperacillin / sulbactam and amikacin and other sensitive antimicrobial agents after adequate treatment of infection than the consultation before significant recovery (P <0.05). Among 27 cases with renal insufficiency, 17 cases (62.9%) had a ratio of urea to creatinine> 20. Antibacterials were not reduced in both groups, but both the infection index and renal function were improved (P <0.05). Forty-five patients (53.49%) had hypoproteinemia. The index of infection decreased after treatment and the protein level increased (P <0.05). Conclusion: Elderly patients with cerebral infarction and pulmonary infection should choose sensitive antimicrobial agents with low drug resistance alone or in combination; patients with renal insufficiency should determine the nature of renal failure, adjust the amount of antibacterials appropriately, and combine malnutrition Of patients, the timely increase in protein intake can promote infection control. Patients with cerebral infarction and pulmonary infection should be combined with clinical symptoms and laboratory indicators, rational development of anti-infective drug treatment programs.