【摘要】目的:评价盐酸左氧氟沙星序贯疗法治疗老年人下呼吸道细菌感染的临床疗效和经济效果。方法:78例下呼吸道细菌性感染老年患者随机分为两组,序贯组(Ａ组)42例,采用盐酸左氧氟沙星500 ｍｇ/ｄ,静脉滴注2 ｄ～4 ｄ,继之以盐酸左氧氟沙星胶囊500 ｍｇ/ｄ,口服5 ｄ～10 ｄ;对照组(Ｂ组)36例,采用盐酸左氧氟沙星500 ｍｇ/ｄ,静脉滴注,疗程7 ｄ～14 ｄ。治疗结束后进行成本效果分析。结果:Ａ、Ｂ两组痊愈率分别为50.0%和52.8%,有效率分别为85.7%和83.3%,细菌清除率分别为84.8%和83.9%,不良反应发生率分别为4.8%和2.8%;经统计学比较,两组疗效相似(Ｐ>0 05),但Ａ组的成本效果比低于Ｂ组。结论: 盐酸左氧氟沙星序贯疗法与单纯静脉滴注治疗相比,两者临床疗效相似,但前者显著降低了总医疗费用,值得临床应用推广。
【关键词】下呼吸道细菌感染；盐酸左氧氟沙星；序贯疗法；效果分析
Costeffectiveness Analysis of Sequential Therapy of Levofloxacin Hydrochloride for Bacterial infection of Lower Respitatory Tract
Abstract: Objective To evaluate clinical therapeutic effect and economic effects of sequential therapy of levofloxacin hydrochloride for bacterial infection of Lower respitatory tract(LRT). Methods 78 cases with bacterial infection of LRT were randomly divided into two groups.43 cases in sequential group(group A)were treated with IV injection of levofloxacin hydrochloride 500 mg/d for 2 days～4 days,then took levofloxacin hydrochloride capsules 500 mg/d for 5 days～10 days;36 cases in control group(group B) were treated with IV injection of levofloxacin hydrochloride 500 mg/d for 7 days～14 days.Costeffectiveness analysis were made after ending the treatment. Results The healing rate of group A and group B was respectively 50.0% and 52.8%;the effective rate was respectively 85.7% and 83.3%;bacteria clearance rate was respectively 84.8% and 83.9%;the incidence rate of adverse reactions was respectively 4.8% and 2.8%.By sta无忧论文 【http://www.uklunwen.com】tistical comparison,therapeutic effect between the two group was simila (P>0.05),but costeffectiveness ratio in group A was lower than that in group B. Conclusion Comparison between sequential therapy of levofloxacin hydrochloride and simple IV injection is found to be similar in clinical theraputic effect,but the former obviously decreases total medical cost,so it is worthy to be spread in the clinic.
Key words: Lower respitatory tract bacterial infection; Levofloxacin hydrochloride; Sequential therapy; Costeffectiveness analysis
在我国,目前临床使用的抗生素品种繁多,抗生素的用药金额已占到药品总金额的40%左右,而用药费用已占到医疗总费用的50%左右［1］。左氧氟沙星是氟喹诺酮类抗菌新药,与沿用氟喹诺酮类抗生素相比,增强了对革兰阳性球菌的抗菌活性,但仍保持了对需氧革兰阴性杆菌的良好抗菌作用［2，3］，其口服制剂吸收完全,生物利用度近100%,此药代动力学特性,使先注射剂继以口服剂的序贯疗法在临床上得以广泛使用［2，3］。我们选择临床上常用的新型喹诺酮类药物盐酸左氧氟沙星作为治疗药物,对“静脉转口服”的序贯疗法在治疗下呼吸道细菌感染中的临床疗效及经济学效果与连续静脉输注的疗法进行比较,为临床合理应用抗生素和治疗决策提供客观依据，现将结果报道如下。
1资料和方法
1.1病例选择2005年6月至2006年6月我院住院的根据临床症状、体征及Ｘ线胸片和细菌学检查等诊断为下呼吸道感染的患者,体温≥38℃,入院前1周未用过抗生素治疗或用过但已证实无效,无严重心、肝、肾等合并症。78例患者,男43例,女35例;年龄60岁～80岁，其中肺炎33例,急性支气管炎7例,慢性支气管炎急性发作29例,支气管扩张合并感染9例。随机分为两组,其中序贯组(Ａ组)42例,对照组(Ｂ组)36例。Ａ组与Ｂ组在性别、年龄、平均体重,治疗前体温、白细胞及细菌阳性率等方面差异均无显著性(P>0.05)。
1.2治疗方案Ａ组:序贯治疗,即先采用盐酸左氧氟沙星注射液［由第一制药(北京)有限公司提供,商品名可乐必妥,规格:500 ｍｇ/100 ｍｌ］,每天500 ｍｇ,静脉滴注2 ｄ～4 ｄ,病情好转后停用针剂,继之以左氧氟沙星片剂［由第一制药(北京)有限公司提供,商品名可乐必妥,规格:500 ｍｇ/片］,500 ｍｇ/次,1次/d,口服5 ｄ～10 ｄ;Ｂ组:单用静脉输注治疗,即采用盐酸左氧氟沙星注射液(产地同上),每天500 ｍｇ,静脉滴注,疗程7 ｄ～14 ｄ。
1.3观察项目比较盐酸左氧氟沙星静脉滴注和序贯疗法的疗效和不良反应,记录序贯疗法改药的时间、方法和步骤,记录每位患者的治疗用药、检查、护理和所涉及的费用以及住院天数。
1.4疗效判断标准
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论文题目：
左氧氟沙星序贯疗法治疗老年人下呼吸道细菌感染的效果分析 
