慢性阻塞性肺的疾病急性加重期的抗菌药物应用_COPD指南解读_周庆涛.pdf

中国药物应用与监测 2011年4月 第8卷 第2期 Chinese Journal of Drug Application and Monitoring, Vol.8, No.2, April 2011 ·专家论坛· 慢性阻塞性肺疾病急性加重期的抗菌药物应用 —COPD指南解读 周庆涛，贺 蓓（北京大学第三医院呼吸科，北京 100191） [摘要] 慢性阻塞性肺疾病（COPD）是导致死亡的主要疾病之一，急性加重是指该病自然病程中出现的以呼吸困难、咳嗽和 （或）咳痰加重为特征的急性事件，对患者危害大。气管- 支气管感染是导致COPD患者急性加重的最主要原因，合理使用抗 菌药物可使患者获益。经验性抗菌药物使用可根据患者急性加重程度、是否存在影响转归的危险因素、是否存在铜绿假单胞 菌感染的危险因素、以及本地区病原菌构成及细菌耐药情况进行选择，β-内酰胺/β-内酰胺酶抑制剂、头孢菌素、氟喹诺酮类 药物临床疗效较好。对??始治疗方案反应欠佳时，应根据细菌培养及药敏试验结果调整抗菌药物。生物标记物C-反应蛋白 和降钙素原有助于指导抗菌药物使用。 [关键词] 慢性阻塞性肺疾病；急性加重期；抗菌药物；指南；合理用药 [中图分类号] R563；R978.1 [文献标识码] A [文章编号] 1672 – 8157(2011)02 – 0065 – 04 Use of antibacterial agents in acute exacerbation of chronic obstructive pulmonary disease —Interpretation of COPD guidelines ZHOU Qing-tao, HE Bei(Department of Respiratory Medicine, Peking University Third Hospital, Beijing 100191, China) [ABSTRACT] Chronic obstructive pulmonary disease (COPD) is one of the major causes leading to chronic morbidity and mortality throughout the world. An acute exacerbation of COPD is defined as an event in the natural course of the disease characterized by an acute change in patients baseline dyspnea, cough and/or sputum beyond day-to-day variability sufficient to warrant a change in the therapy. COPD exacerbation has serious negative impacts on the lung function and life quality of patients. The most common cause for exacerbation is the infection of tracheobronchial tree, patients can get benefit from rational use of antibacterial agents. Antibacterial agents can be empirically selected according to the severity of acute exacerbation, risk factors that affect turnover, risk factors for infection of P. aeruginosa, and the structure and resistance of pathogenic bacteria. Beta-lactam/ beta-lactamase inhibitor combinations, cephalosporins and fluoroquinolones are the most appropriate antibacterial agents for acute exacerba