我国医院内肺炎流行病学现状:20世纪90年代发表论文的荟萃分析

Epidemiology of Nosocomial Pneumonia in China: Meta analysis for Literature Published in 1990s

目的 研究我国医院内肺炎 (NP)的发病率、病死率、常见临床表现和病原谱 ,为今后制订 NP的控制规划提供依据。方法 通过广泛的文献检索和搜集 ,采用近年来国外已频繁应用的统计新概念 Meta(荟萃 )分析 ,对我国 2 0世纪 90年代发表的专门研究院内肺炎的临床流行病学调查结果进行汇总、归纳和统计分析。结果 共检索到文献 344篇 ,有 88篇进入 Meta分析 ,总计报告 NP病例 870 5例 ;其中 32篇论文可用于 NP发病率的统计 ,所监测的 17885 1例住院患者中 ,发生 NP416 6例 ,NP总体发病率为 2 .33% ;不同人群 NP发病率差异很大 ,老年、ICU和机械通气患者 NP发病率分别为普通住院患者的 5 .39、12 .78、43.2 7倍 ;5 1篇研究提供有关 NP预后即死亡的数据 ;监测的 44 6 8例 NP中死亡 10 76例 ,总体病死率为 2 4.0 8% ;6 3篇提供 NP病原学检查结果 ,大多数为经咯痰细菌培养获得检出的 6 0 2 6株病原菌中 ,革兰阴性杆菌 42 2 6株 ,占 70 .1% ;革兰阳性球菌 12 41株 ,占 2 0 .6 %。结论 我国 NP的平均发病率为 2 .33% ,高于全国医院感染监测网 1.0 %～ 1.5 %的发病率 ,病死率2 4.0 8% 。

OBJECTIVE To understand the morbidity, mortality,clinical manifestation and pathogen spectrum of nosocomial pneumonia(NP) in China via systematically reviewing available articles published in 1990s.METHODS Data sources: all articles from 1990 to 1998 relevant to NP in main land of China were identified through“CBMdisc” and “Medline” search and article bibliographies.Study selection: 344 articles were identified, 88 articles were selected for meta analysis based on inclusion and criteria.Data extraction:occurrence rates for morbidity and mortality,clinical manifestation and pathogens were extracted.RESULTS A total of 8 705 NP cases were reported in 88 articles. Data could be extracted for morbidity analysis in 32 articles; 4 166 NP were identified among 178 851 hospitalized patients.The general incidence of NP is 2.33%.The incidence of NP in elderly, ICU, mechanical ventilation patients are 5.39%,12.78%,43.27%,respectively.Data could be extracted for mortality analysis in 51 articles;1 076 deaths were observed in 4 468 NP.The general fatal rate of NP is 24.08%.Pathogens of 6 026 strains were identified in 63 articles; 4 226(70.1%) strains were gram negative rods and 1 241(20.6%) were gram positive cocci.CONCLUSIONS Mortality of NP in the meta analysis is much higher than the data reported routinely in National Nosocomial Infection Surveillance Net.Elderly, ICU and mechanical ventilation are important risk factors of NP in China.