关键词：肺；结核；抗多种药物；药物；治疗学
摘要 为分析耐多药肺结核的成因并探讨治疗对策，对24例耐多药肺结核患者病史进行分析。痰结核菌检测及药敏测试，用3AKHPOX/HPOX方案治疗并观察痰、胸片变化及药物毒副作用，有适应证者行外科手术加内科治疗。结果表明：MDR-PTB75%由不规则化疗引起，包括医师、患者及药物等诸多人为因素；25%为初始耐药。内科治疗近期有效率为83%，停药2年痰菌复发率为12.5%，外科手术加内科治疗近、远期疗效均好。提示加强宣教、强调结核病归口管理，提高综合医院医师对结核病的认识，保证初治患者治疗规则、彻底，是防止MDR-PTB产生的关键，对MDR-PTB采用含大剂量异烟肼、氧氟沙星和其它二线药物的方案治疗是可行和安全的。
Multi-drug resistant pulmonarytuberculosis: clinical analysis of 24 cases
Lei Baozhong
Guangxi Longtang Hospital, Liuzhou, Guangxi, P.R.China 545005
To analyse the cause resourses ofmulti-drug resistant pulmonary tuberculosis (MDR-PTB) and its therapy, case history of 24patients were reviewed. Sputum examination for tubercle bacillus and drug senitive testhad been done for them. Patients received 3AKHPOX/HPOX regimen and sputum, chest X-rayfilm changes and side-effects had been evaluated. Patients with indication receivedmedical and surgical treatment. 75% MDR-PTB induced by irregular chemotherapy, includinghuman factors as doctors, patients and drugs; 25% preliminary drug resistance. Short-termeffective rate of medical treatment was 83%, recurrence rate of sputum cells two yearsafter stopping drugs was 12.3%. Both short term and long term treatment of medical andsurgical therapies had good results. It indicated that the key to preventing MDR-PTB isthat physicians should know more about tuberculosis and give patients complete regulartreatment. It is safe and effective for the treatment of MDR-PTB with high dose isoniazid,ofloxacin and other second drugs.
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