社区获得性肺炎160例初始治疗回顾分析

Clinical Analysis of the Initial Treatment in Patients with Community Acquired Pneumonia

目的探讨社区获得性肺炎(community-acquired pneumonia,CAP)初始治疗中存在的问题,以加强CAP的规范化治疗。方法对我院2011年1月—2012年3月收治的CAP 160例临床资料进行回顾性分析。结果本组均收住普通病房,英国胸科协会改良肺炎评分(CURB-65评分)轻度35例,中度82例,重度43例;入院前已在门急诊治疗106例,有完整初始用药资料者62例,4 h内抗感染药使用率为56%(35/62);初诊当天入院的54例,初诊后4 h内抗感染药使用率100%。160例中应用单一抗菌药物者占61.3%(98/160),联合应用2种抗菌药物者占38.7%(62/160)。本组初始治疗有效率为72.5%,其中确诊当天入院的54例有效率85.2%(46/54),入院前已在门急诊初始治疗106例有效率66.4%(70/106)。本组均在应用抗感染药后留取痰标本行痰涂片及细菌培养,阳性率28.75%(46/160)。结论本组初始治疗存在未根据病情评估选择初始治疗地点、抗菌药物选择欠规范、门急诊初始经验性抗感染治疗不够及时、留取病原体培养标本不及时等问题,加强门急诊医师的培训和管理是实现CAP规范诊治的关键。

Objective To explore problems of initial treatment in patients with community acquired pneumonia （CAP） so as to strengthen standardization of CAP treatment. Methods Clinical data of 160 patients with CAP during January 2011 and March 2012 in our hospital was retrospectively analyzed. Results These patients were admitted to ordinary ward, and the CURB65 scores showed 35 patients with mild, 82 patients with moderate and 43 patients with severe symptom; 106 patients underwent initial treat ment in outpatient department or emergency department, 62 patients had complete initial medication information, and usage rate of antiinfective agents within 4 h was 56% （35/62） ; usage rate of antiinfective agents within 4 h in 54 patients who were given anti bacterial drug on the day of the initial treatment was 100%. The 98 patients （61.3%） used a single antimicrobial drug, and 62 pa tients （38.7%） used two kinds of antimicrobial drugs. Total effective rate of initial treatment in the group was 72.5%. Among them, effective rate in 54 patients confirmed on the day of admission was 85.2% （46/54）, and effective rate in 106 patients gave initial treatment in outpatient department or emergency department before admission was 66.4% （70/106）. Bacterial culture was performed after using antibacterial drug, and the positive rate of the group was 28.75% （46/160）. Conclusion The problems of initial treatment for CAP are choice of treatment place without evaluating pathogenetic condition, nonstandard usage of antibacterial drug, untimely experiential antiinfective therapy in outpatient department or emergency department and late collection of sputum specimen. So improvement of training and management of clinicians for standard therapy is the key to achieve norm treatment of CAP.