大叶性肺炎患儿初选治疗与重新评估效果分析

Effect of primary treatment and reevaluation on lobar pneumonia in children

目的分析大叶性肺炎患儿初选治疗及重新评估效果,为保障患儿健康提供经验及依据。方法选择医院2014年1-12月大叶性肺炎住院患儿135例,从临床资料、治疗、预后、住院日与住院费用等的初选治疗、重新评估后治疗效果及需要重新评估患儿临床特点进行分析。结果 135例患儿中共有39例需要重新评估及重新选择诊疗方案,其因素依次为反复呼吸道感染、喘息过敏史、感染危险菌株等,分布率依次为38.46%、30.77%、25.64%;在细菌培养中肺炎克雷伯菌仍为重要致病菌占30.00%,其次为大肠埃希菌占23.33%、金黄色葡萄球菌占16.67%;初始治疗应用抗菌药物哌拉西林/他唑巴坦治疗有效率为51.11%;初选有效治疗在住院日及住院费用方面优于重新评估患儿,差异有统计学意义(P<0.05)。结论大叶性肺炎患儿根据经验及初步检查选择治疗有效抗菌药物,并应积极针对合并有危险因素的患儿加强护理、及时评估,可缩短住院日,减少住院费用。

OBJECTIVE To study the effect of primary treatment and reevaluation on lobar pneumonia in children and provide experience and basis to guarantee health for children .METHODS Totally 135 children with lobar pneu‐monia in our hospital from Jan .to Dec .2014 were selected ,and the information of children was analyzed including genders ,ages ,seasons ,symptoms ,complications ,laboratory examination ,imaging examination ,examination of etiology ,treatment and prognosis ,hospitalization days and hospitalization expenses ,etc .,to explore the efficacy of the primary treatment ,the treatment efficacy after the reevaluation and the clinical characteristics of those chil‐dren w ho needed reevaluation .RESULTS Among the 135 children ,39 children needed reevaluation and re‐selection of treatment regimen due to recurrent respiratory tract infection （the distribution rate 38 .46% ） ,allergy history （30 .77% ） ,infection with dangerous bacteria （25 .64% ） . K lebsiella pneumoniae was still the important patho‐genic bacteria （17 .65% ） ,followed by Escherichia coli （13 .72% ） ,Staphylococcus aureus （9 .80% ） .In primary treatment ,the efficacy of piperacillin/tazobactam was 51 .11% .The effective primary treatment was superior to reevaluation in hospital stay and hospital costs（P〈0 .05） .CONCLUSION For lobar pneumonia in children ,selec‐tion of effective antibacterials according to experience and primary examination as well as active enforced nursing and timely evaluation for children associated with risk factors can shorten the hospitalization days and reduce hos‐pitalization expenses .