经验性抗感染治疗社区获得性肺炎疗效评价

Evaluation on the efficacy of initial empirical antimicrobial therapy for patients with community acquired pneumonia

目的评价经验性抗感染治疗社区获得性肺炎(Community acquired pneumonia,CAP)的临床疗效。方法以急诊病区CAP患者为研究对象,依据肺炎严重程度评分(PSI)分为高、中、低危人群,前瞻性应用抗感染治疗方案(阿奇霉素或左氧氟沙星、或联合二、三、四代头孢),评价其疗效。结果 78例患者中,男54例(69.2%),女24例(30.8%),年龄14～99岁,平均(67.6±17.5)岁,其中CAP60例(76.9%),CAP伴胸膜炎18例(23.1%)。所有患者中,低危人群26例(33.3%),中危人群30例(38.5%),高危人群22例(28.2%);几种治疗方案7d好转率(有效+显效)为59.0%(46例)、临床治愈率为41.0%(32例)、总有效率(好转+治愈)为100%(78例);14d治愈率为43.6%(34例);21d治愈率为14.1%(11例)。结论阿奇霉素或左氧氟沙星、或联合二、三、四代头孢类抗菌药物经验性抗感染治疗CAP疗效确切可靠。

Objective To evaluate the clinical efficacy of initial empirical antimicrobial therapy for patient with community acquired pneumonia （CAP）. Methods Patients with CAP in the emergency ward were divided into high, moderate or low risk groups according Pneumonia Severity Index （PSI）, and treated by several programs of empirical antimicrobial therapy （Azithromycin or levofloxacin or combined with the second, third, fourth generation cephalosporins）. The clinical data were collected to evaluate and compare their efficacy. Results A total of 78 patients were enrolled in this study, including 54 males （69.2%） and 24 （30.8%） females, aged 14～99 years old, （67.6±17.5） in average. They were 60 cases （76.9%） of CAP, and 18 cases （23.1%） of CAP combined with pleurisy. Twenty-six patients （33.3%） were of low-risk group, with 30 patients （38.5%） of moderate-risk group and 22 patients （28.2%） of high-risk group. During seven days, the improvement rate, cure rate, and the total effective rate were 59.0% （46/78） and 41.0% （32/78）, 100% （78/78）, respectively. The cure rate was 43.6% （34/78） during 14 days and 14.1% （11/78） during 21 days. Conclusion It is effective and reliable to treat CAP by empirical antimicrobial therapy of azithromycin or levofloxacin or combined with the second, third, fourth generation cephalosporins.