我院耐多药结核病治疗管理及药品不良反应发生情况分析
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篇名: 我院耐多药结核病治疗管理及药品不良反应发生情况分析
TITLE:
摘要: 目的:为耐多药结核病(MDR-TB)患者合理使用抗结核药及减少药品不良反应(ADR)提供参考。方法:选取2012年2月-2015 年5月我院结核病住院患者,按照疑似MDR-TB(202例)和确诊MDR-TB(162例)分为两组,进行药物组化疗法,并依据患者病情选择不同的治疗管理方式,并观察ADR发生情况。两组患者的治疗管理期均为18个月。结果:疑似MDR-TB组患者对一线药物的耐药率均≥26.24%,其中对异烟肼和利福平的耐药率为40%左右;对二线药物的耐药率均≥4.95%,其中对丙硫异烟胺耐药率最高,为46.04%;药敏试验结果显示,一线药物全敏感为44.06%,单耐药为14.36%,多耐药为9.90%,耐多药为31.68%;一、二线药物全敏感为21.78%,单耐药为24.75%,多耐药为17.82%,耐多药为32.67%,广泛耐药为2.97%。MDR-TB患者治疗管理方案中,结防机构治疗占56.17%;转诊于专科医院治疗占14.81%;未治疗者占22.22%;其他因素导致改变治疗方案或无法继续治疗占6.79%。确诊MDR-TB患者较疑似MDR-TB患者二线方案诊疗的ADR发生率较高,组间比较差异有统计学意义(P<0.05)。经后期对症治疗均有所好转。结论:对于MDR-TB患者根据病情可有效寻找合适的治疗管理方案,提高疗效,降低ADR发生率,控制结核杆菌的传播与发展。
ABSTRACT: OBJECTIVE: To provide reference for rational use of antituberculosis drugs and reduce the occurrence of ADR in multiple-drug resistance tuberculosis (MDR-TB) patients. METHODS: TB inpatients were selected from our hospital during Feb. 2012-May 2015, and then divided into suspected MDR-TB group (202 cases) and diagnosed MDR-TB group (162 cases). According to the patient’s condition, different treatment management modes were chosen, and the incidence of ADR were observed. Treatment and management period of 2 groups were 18 months. RESULTS: In suspected MDR-TB group, the drug resistance rates to first line drugs were greater than or equal to 26.24%, among which drug resistance rates to isoniazid and rifampicin were about 40%. Resistance rates to second line-drugs were greater than or equal to 4.95%, among which resistance rate to protionamide was the highest, being 46.04%. The results of drug sensitivity tests showed that 44.06% of patients were sensitive to all first-line drugs, 14.36% of patients were resistant to single drug, 9.90% of patients were usually resistant to drugs and 31.68% of patients were resistant to multiple drugs. 21.78% of patients were sensitive to all first-line drugs and second-line drugs, 24.75% of patients were resistant to single drug, 17.82% of patients were usually resistant to drugs, 32.67% of patients were resistant to multiple drugs and 2.97% of patients were extensively resistant to drugs. In the management plan of MDR-TB patients therapy, 56.17% were treated in tuberculosis control institutions; referral to special hospital for treatment accounted for 14.81%; 22.22% didn’t receive any treatment; other factors lead to a change in treatment or unable to continue to treat accounted for 6.79%. The incidence of ADR in MDR-TB patients was higher than suspected MDR-TB patients, there was statistical significance between 2 groups (P<0.05). After the following symptomatic treatment, all patients were improved. CONCLUSIONS: For patients with MDR-TB, according to disease condition, appropriate treatment management program can be found so as to improve therapeutic efficacy, reduce the incidence of ADR, control spreading and development of tubercle bacillus.
期刊: 2017年第28卷第32期
作者: 杜德兵
AUTHORS: DU Debing
关键字: 耐多药结核病;治疗管理;药品不良反应;临床分析
KEYWORDS: MDR-TB; Treatment management; ADR; Clinical analysis
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