目的 探讨多粘菌素B联合头孢哌酮钠舒巴坦钠和替加环素对多重耐药鲍曼不动杆菌肺炎患者的疗效及安全性。方法 选择2017年9月-2019年9月在新疆维吾尔自治区人民医院收治的80例多重耐药鲍曼不动杆菌肺炎患者作为研究对象，按照治疗方法的不同分为对照组与观察组，每组各40例。对照组患者静脉滴注注射用头孢哌酮钠舒巴坦钠，3 g加入到0.9%氯化钠溶液中，每隔12 h静滴，2 h之后静滴注射用替加环素，首剂用量100 mg，之后每隔12 h静滴50 mg进行维持，2次/d。观察组在对照组治疗的基础上静脉滴注注射用硫酸多粘菌素B，100~150万单位/d，分2~3次静脉滴注。两组疗程共14 d。观察两组患者的临床疗效和细菌清除率，比较两组患者白细胞计数（WBC）、血清C反应蛋白（CRP）、降钙素原（PCT）水平。结果 治疗后，两组总有效率比较差异没有统计学意义。治疗后，两组患者的WBC、CRP和PCT水平均较治疗前明显降低（P<0.05），且观察组患者WBC、CRP和PCT水平显著低于对照组（P<0.05）。治疗后，观察组的细菌清除率为87.5%，明显高于对照组的62.5%，两组比较差异有统计学意义（P<0.05）。结论 多粘菌素B联合头孢哌酮钠舒巴坦钠和替加环素治疗多重耐药鲍曼不动杆菌肺炎效果较好，值得临床推广。

Objective To investigate the efficacy and safety of polymyxin B combined with cefoperazone sodium and sulbactam sodium and tigecycline in treatment of patients with multi-drug resistant acinetobacter Baumannii pneumonia. Methods A total of 80 patients with multidrug-resistant acinetobacter Baumannii pneumonia admitted to the People's Hospital of Xinjiang Uygur Autonomous Region from September 2017 to September 2019 were selected as the research subjects and divided into control group and observation group according to different treatment methods, with 40 cases in each group. Patients in the control group were iv administered with Cefoperazone Sodium and Sulbactam Sodium for injection, 3 g was added to 0.9% sodium chloride solution, intravenous infusion every 12 h, 2 h later, intravenous infusion of Tigecycline for Injection, the first dose was 100 mg, and then intravenous infusion of 50 mg every 12 h for maintenance, twice daily. Patients in the observation group was iv administered given Polymyxin B Sulfate for Injection on the basis of control group, 1 to 1.5 million U/d, divided into 2 to 3 intravenous infusion. Patients in two groups were treated for 2 weeks. After treatment, clinical efficacy and bacterial clearance rate of two groups were observed, and the levels of WBC, CRP and PCT were compared. Results After treatment, there was no significant difference in total effective rate between two groups. After treatment, the levels of WBC, CRP, and PCT in two groups were significantly lower than those before treatment (P<0.05), and the levels of WBC, CRP, and PCT in observation group were significantly lower than those in control group (P<0.05). After treatment, the bacterial clearance rate of the observation group was 87.5%, which was significantly higher than 62.5% of the control group, and the difference between two groups was statistically significant (P<0.05). Conclusion Polymyxin B combined with cefoperazone sodium and sulbactam sodium and tegecyclin in treatment of multi-drug resistant acinetobacter Baumannii pneumonia has a good effect, and is worthy of clinical promotion.

R974

新疆维吾尔自治区自然科学基金（2020D01C100）