基于CPIS评分用药指导对细菌感染所致老年重症肺炎患者用药时间及用药频度的影响

Effect of medication guidance based on CPIS score on medication time and DDDs of elderly patients with severe pneumonia caused by bacterial infection

目的探讨基于肺部感染评分(CPIS)用药指导对细菌感染所致老年重症肺炎患者用药时间及用药频度(DDDs)的影响.方法选择2017年1月至2019年6月温州医科大学附属第三医院呼吸内科收治的120例老年重症肺炎患者,其中2017年1月至2018年3月收治的60例为对照组,2018年4月至2019年6月收治的60例为研究组.对照组给予常规抗菌治疗;研究组给予CPIS评分为基础的用药指导干预,即首次CPIS评分≥5分者首选耐酶、抗菌谱广的第3代头孢类抗菌药物治疗,同时检测患者外周血白细胞计数(WBC)、体温、气道分泌物等变化,2~3d后进行CPIS动态评分,若<5分则2d后评分,若仍<5分则停止使用抗菌药物.记录两组老年重症肺炎患者抗菌药物使用情况,包括抗菌药物使用种类、抗菌药物使用时间和DDDs等;比较两组患者住院时间和病死率;评价两组患者治疗后的有效率.结果研究组抗菌药物使用种类(种:2.37±1.32比2.85±1.20)、抗菌药物使用时间(d:7.43±2.83比9.86±2.05)、DDDs(17.54±7.32比22.78±6.74)、住院时间(d:14.38±4.03比22.74±4.56)、病死率[13.33%(8/60)比28.33%(17/60)]均明显低于对照组(均P<0.05),治疗后有效率明显高于对照组[86.67%(52/60)比71.67%(43/60),(P<0.05)].结论给予CPIS评分用药指导能够显著降低细菌感染所致老年重症肺炎患者抗菌药物使用种类数和使用时间以及DDDs,降低病死率,提高治疗有效率,具有较好的临床应用价值.

Objective To explore the influence of the medication guidance based on clinical pulmonary infection score(CPIS)on the medication time and DDDs of the elderly patients with severe pneumonia caused by bacterial infection.Methods From January 2017 to June 2019,120 elderly patients with severe pneumonia in Department of Respiratory Medicine of the Third Affiliated Hospital of Wenzhou Medical University were selected,60 patients admitted from January 2017 to March 2018 were selected as the control group,and 60 patients admitted from April 2018 to June 2019 were selected as the research group.The patients in control group were given routine antibacterial treatment,and the patients in research group were given medication guidance intervention based on CPIS score.The patients with CPIS score≥5 for the first time were treated with the third generation cephalosporins with broad spectrum of antibiotic and enzyme resistance.At the same time,the changes of white blood cell(WBC),body temperature,airway secretion and so on were detected.After 2-3 days,the patients were scored with CPIS dynamically.If the score was less than 5,the patients were scored 2 days later.If the score was still less than 5,the antibiotics were stopped.The use of antibiotics in the two groups was recorded,including the type of drugs and medication duration,and DDDS.The prognosis of the patients was recorded,including length of stay and fatality rate.The effective rates of the two groups were evaluated after treatment.Results In research group,the types of antibiotics(types:2.37±1.32 vs.2.85±1.20),medication duration(d:7.43±2.83 vs.9.86±2.05),DDDs(17.54±7.32 vs.22.78±6.74)and length of hospitalization(d:14.38±4.03 vs.22.74±4.56)were significantly lower than those in control group(all P<0.05).The effective rate of research group was significantly higher than that of control group[86.67%(52/60)vs.71.67%(43/60),P<0.05],and the fatality rate was significantly lower than that of the control group[13.33%(8/60)vs.28.33%(17/60),P<0.05].Conclusion Giving CPIS score-based medication guidance can significantly reduce the medication duration and DDDs of the elderly patients with severe pneumonia caused by bacterial infection,reduce the fatality rate,and improve the treatment efficiency,with better clinical application value.