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目的 总结肿瘤患者粒细胞缺乏症并感染的经验性抗生素治疗的临床经验。方法 回顾性分析 119例肿瘤患者 2 4 8例次的临床资料 ,观察头孢哌酮 (CFP)、氧哌嗪青霉素 (PPC)、头孢他定 (CTZ)、亚胺培南 (IMP)与丁胺卡那霉素 (AMK)分别组成BA、PA、CA、TA方案的疗效及副作用。结果 BA、PA、CA、TA方案分别治疗 10 3、87、35和 2 3例次 ,治疗的中位时间为 7～ 8d ,有效率分别为 6 3%、4 8%、6 8%和 74 % ,PA方案明显为低 (P <0 0 5 )。治疗无效者调整治疗 :改用CA或TA方案加减去甲万古霉素 (NVC)及抗真菌治疗 ;总有效率分别为 88%、83%、86 %和 91%。最常见副作用为胃肠功能紊乱 ,腹泻为 12 % ,皮疹和肝转氨酶轻度升高分别为 4 % ;2例NVC和AMK治疗者出现明显的听力下降和肾脏毒性。结论 BA、CA、TA方案具有相似的疗效 ,可作为一线经验性治疗方案。经验性治疗无效者 ,应改用具有更高抗菌活性的方案或尽早采用NCV和 (或 )抗霉菌治疗
Objective To summarize the clinical experience of empiric antibiotic therapy for neutropenia and infection in cancer patients. Methods The clinical data of 248 patients with 119 tumors were retrospectively analyzed. The effects of cefoperazone (CFP), penicillin (PPC), ceftazidime (CTZ), imipenem and butylamine Kanamycin (AMK), respectively, the composition of BA, PA, CA, TA program efficacy and side effects. Results The BA, PA, CA and TA regimens were treated with 103, 87, 35 and 23 cases respectively. The median time to treatment was 7 to 8 days. The effective rates were 63%, 48%, 68% and 74% %, PA regimen was significantly lower (P <0 05). Treatment ineffective adjustment treatment: use of CA or TA program plus minus vancomycin (NVC) and antifungal therapy; total effective rates were 88%, 83%, 86% and 91%. The most common side effects were gastrointestinal disorders with 12% of diarrhea and mild rash and hepatic transaminase elevation of 4%, respectively; two patients with NVC and AMK had significant hearing loss and nephrotoxicity. Conclusion The BA, CA and TA regimens have similar curative effect and can be used as a first-line empirical treatment plan. Those who are not empirically treated should use a regimen with higher antibacterial activity or early treatment with NCV and / or anti-mold