氨基糖苷類藥物在重度感染患者中的應(yīng)用

摘 要 氨基糖苷類藥物主要用于敏感需氧革蘭陰性桿菌所致感染治療。因耳毒性和腎毒性等不良反應(yīng)，使其在臨床上、尤其是在重度感染中的應(yīng)用受到較大限制。但氨基糖苷類藥物屬靜止期殺菌劑，對(duì)常見革蘭陰性桿菌如銅綠假單胞菌、肺炎克雷伯菌和大腸埃希菌等的抗生素后效應(yīng)較長(zhǎng)、殺菌作用完全，在治療需氧革蘭陰性桿菌和陽(yáng)性菌所致重度感染治療中有著不可替代的作用。

關(guān)鍵詞 氨基糖苷類藥物 重度感染 治療

中圖分類號(hào)：R978.12 文獻(xiàn)標(biāo)識(shí)碼：A 文章編號(hào)：1006-1533(2012)07-0008-05

The application of aminoglycoside antibiotics in severe infections

Li Feng， Wang Chun-hua

(The Intensive Care Unit of the First People’s Hospital of Nantong City， Nantong， 226001)

Abstract Aminoglycoside antibiotics are a class of antibacterial agents having the structure of amino sugar and aminocyclitol， which is effective against the infections caused by the sensitive aerobic Gram-negative bacilli. Because of its side effects of ototoxicity and nephrotoxicity and so on， it is restricted in the clinical usage especially in severe infections. But the aminoglycoside antibiotics are a quiescent bactericide. It has longer post antibiotic effect on the common Gram-negative bacilli such as Pseudomonas aeruginosa， Klebsiella pneumonia， Escherichia coli and complete bactericidal action. So aminoglycoside antibiotics play an irreplaceable role in treatment of severe infections caused by aerobic Gram-negative bacilli and positive bacteria.

Key words aminoglycoside antibiotics; severe infection; treatment

氨基糖苷類藥物是指具有氨基糖與氨基環(huán)醇結(jié)構(gòu)的一類抗菌藥物，主要用于敏感需氧革蘭陰性桿菌所致感染治療。近20年來(lái)，由于頭孢菌素類和喹諾酮類等抗菌藥物在臨床上得到廣泛應(yīng)用，加上氨基糖苷類藥物有明顯的耳毒性和腎毒性，故此類藥物在臨床上、尤其是在重度感染患者中的應(yīng)用受到較大限制。但氨基糖苷類藥物屬靜止期殺菌劑，對(duì)常見革蘭陰性桿菌如銅綠假單胞菌、肺炎克雷伯菌和大腸埃希菌等的抗生素后效應(yīng)（PAE）較長(zhǎng)、殺菌作用完全，可與β-內(nèi)酰胺類抗菌藥物或萬(wàn)古霉素等糖肽類抗菌藥物聯(lián)合用藥治療需氧革蘭陰性桿菌和陽(yáng)性菌所致重度感染，在臨床上仍有著不可替代的作用。

1 分類及藥效學(xué)特點(diǎn)

氨基糖苷類藥物易溶于水，按來(lái)源可分為兩大類：1）由鏈霉菌產(chǎn)生的抗生素，包括鏈霉素、新霉素、巴龍霉素、利維霉素、卡那霉素、卡那霉素B、妥布霉素、核糖霉素和半合成的阿米卡星等；……