卡泊芬净联合万古霉素治疗肾移植术后肺部感染的疗效观察

Objective To evaluate the efficacy of caspofungin combined with vancomycin in treatment of pulmonary infection after renal transplantation. Methods A total of 122 patients with pulmonary infection after renal transplantation admitted to the First Affiliated Hospital of Xi'an Jiaotong University from August 2018 to October 2019 were selected as study subjects. According to the random number table method, the patients were divided into control group and observation group, with 61 patients in each group. Patients in the control group were iv administered with Norvancomycin Hydrochloride for Injection, 250 mg/time, dissolved in 0.9% sodium chloride injection 250 mL, and the infusion time was less than 1 h, 12 h/time. After 3 days, the dose was adjusted according to the peak value of blood concentration. Patients in the observation group were iv administered with Caspofungin Acetate for Injection on the basis of the control group, the first dose was 70 mg, and 200 mL glucose solution was used for dissolution. The maintenance dose was 50 mg at the beginning of the second day, once daily. The course of treatment in both groups was 14 days. The clinical efficacy of two groups was observed, and the renal function index, lung function index, and blood gas index level before and after treatment were compared. Results After treatment, the total effective rate of the observation group was 91.80%, which was significantly higher than 77.05% of the control group, and the difference between two groups was statistically significant (P < 0.05). After treatment, the bacterial clearance rate of the observation group was 34.43%, which was significantly higher than 14.75% of the control group, and the difference between two groups was statistically significant (P < 0.05). After treatment, ACR, Scr and urine β2-microglobulin were significantly increased in two groups (P < 0.05), and there was no statistically significant difference between two groups. After treatment, lung function indexes of FEV₁, FEV1%pred, and FEV₁/FVC were significantly increased in two groups (P < 0.05). After treatment, lung function indexes in the observation group were significantly higher than those in the control group, with statistically significant differences (P < 0.05). After treatment, SaO₂, pO₂ and OI in two groups were significantly increased, but pCO₂ was significantly decreased (P < 0.05), the difference between two groups before and after treatment was statistically significant (P < 0.05). After treatment, SaO₂, pO₂ and OI in the observation group were significantly higher than those in the control group, and pCO₂ was significantly lower than that in the control group (P < 0.05). Conclusion The combination of caspofungin combined with vancomycin has reliable application value in treatment of pulmonary infection after renal transplantation, which can effectively inhibit the pulmonary infection of patients. The combination of caspofungin combined with vancomycin has a rapid effect, but it still needs to be rationally selected according to the actual situation of patients.