脊柱结核药物治疗回顾性分析

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1、脊柱结核药物治疗回顾性分析秦世炳北京胸科医院北京结核病胸部肿瘤研究所骨科摘要目的探讨脊柱结核患者•的药物治疗方案及时间，以分析确定脊柱结核的最佳结核药物的治疗方案及最佳用药时间。方法回顾性分析我院收治的890例脊柱结核住院患者的药物治疗方案和用药时间，针对不同的发病、临床表现、不同的手术效果分析其结核药物干扰的表现，同时对初治、复治、复发及耐药的患者的治疗方案的应用，还有合并它处结核或合并英它疾病的个性化治疗方案的总结。结果890例脊柱结核中初治596例（67%）,复治294例（占33%）；其中收治的复发病例110例（占12.3%）,耐药74例

2、（7.4%）；合并他处结核的273例（占30.7%）治疗方案以四联为主（H12/R12/E9/Z5/S3）；复治的以添加二线及左氧氟沙星为主；耐药的以二线及静脉输注抗结核药物等，并根据耐药谱应用个性化治疗或随时更换抗结核药物方案，用药时间12〜36个月不等，患者均痊愈。结论脊柱结核是结核分枝杆菌感染引起的脊柱骨感染性破坏，结核菌破坏力强，难杀灭，用药时间长，易形成医源性耐药，因此结核药物治疗是治愈结核的关键，有效和规范抗结核菌药物治疗方案，对于脊柱结核的治疗有着重要意义。关键词脊柱结核,结核药Theretrospectiveanalysisof

3、thechemotherapyinthespinaltuberculosisQinShibingBeijingChestHospital,TheOrthopaedicDepartmentofBeijingTuberculosisandThoracicTumorResearchInstituteAbstractObjective:Toexploretheplanandtimeaboutthechemotherapyinthespinaltuberculosis.Todeterminethebesttherapeuticregimenanddura

4、tionofthespinalanti-tuberculosis.Method:Themedicationplananddurationof890hospitalizationpatientsofspinaltuberculosisinourhospitalwereretrospectivelyinvestigated.Wecollectedtheplanoftheinitialtreatment,retreatment,recrudescenceanddrugresistance・Wealsostudiedtheindividuationth

5、erapeuticregimenofthepatientswithotherpartstuberculosisorcomplications.Onthebasisofsuchdata,weanalyzedtheinterferentialappearancethattheanti-tuberculosisdrugactedondifferentonsets,manifestationsandoperations.Result:In890patientsofspinaltuberculosis,596(67%)wereinitialtreatme

6、nt,294(33%)wereretreatment,recurcaseswere110(12.3%),drugresistancecaseswere74(7.4%),complicatedwithotherpartstuberculosiswere273(30.7%).Themainchemotherapeuticregimenwastheusualtetragenousprotocol(H12/R12/E9/Z5/S3).Theretreatmentcasesweregivensecond-linedrugssuchaslevofloxac

7、in.Thedrugresistancecaseswerealsogivensecond-linedrugsandintravenousinfusion.Accordingtotheanti-tuberclebacillusspectrum,individuationtreatmentswereadopted,andtheplanwaschangedintime.Themedicationdurationcontinuedfor12-36months.Allthe890patientswerecured.Conclusion:Spinaltub

8、erculosiswascausedbythetuberclebacilluswhichinfectedanddemolishedthespine・T