Time to recovery from severe pneumonia and its predictors among pediatric patients admitted in Mizan-Tepi University Teaching Hospital,South West Ethiopia,2022

Objective:Despite trials and programs for the prevention of childhood mortality due to pneumonia,Ethiopia is among the top five countries with the highest number of deaths due to pneumonia.Although the prevalence of pneumonia has increased in the abovementioned trials,little is known about the recovery time from severe pneumonia and its predictors in the study area.Therefore,this study aimed to assess the time to recovery from severe pneumonia and its predictors among pediatric patients admitted to Mizan-Tepi University Teaching Hospital,Ethiopia,in 2022.Methods:A total of 591 children admitted for severe pneumonia were selected using simple random sampling.Data were entered into Epi-data version 4.4.2.1 and expor ted to STATA version 14 for analysis,and the assumptions of Cox propor tional hazard models and goodness of fit were assessed through Shoenfeld residual and Cox-Snell residual,respectively.Bivariate and multivariable Cox regression models were used to identify the predictors of mor tality.Results:This study revealed that 91.54%(95%confidence interval[CI]:89.00–93.53)of participants recovered with an incidence rate of 24.10(95%CI:22.15–26.21)per 100 person-day–observations.The hmedian recovery time of children was 4 days(95%CI:2–6).Children who were not exclusively breastfed(AHR=1.3;95%CI:1.03–1.66),who had a history of inability to suck/feed(AHR=0.81;95%CI:0.65–0.99)were independent predictors of the time to recovery.Conclusions:Children with severe pneumonia who had not exclusively breastfed and who had a history of inability to suck/feed were independent predictors of time to recovery.Therefore,all stakeholders and concerned health care providers should focus more on early diagnosis and management and hasten early recovery based on the identified factors.

The effect on immune function and inflammatory factors of adjuvant antibiotic therapy through Xuebijing combined with thymopentin in elderly patients with severe pneumonian

Objective:To investigate the effect on immune function and inflammatory factors of adjuvant antibiotic therapy through Xuebijing combined with thymopentin in elderly patients with severe pneumonia.Methods:Divided 100 cases of elderly patients with severe pneumonia into the observation group and the treatment group according to odevity of serial number. Fifty patients in each group. Gave control group severe pneumonia conventional treatment, such as mechanical ventilation, antifebrile, removing phlegm and anti-infection, and gave Xuebijing by intravenous drop simultaneously;observation group was given Xuebijing combined with thymopentin by intravenous drop on the base of conventional treatment. Then compared the T lymphocyte subpopulation and serum inflammatory factors level including CRP, IL-6, IL-1 and TNF-α of two groups before treatment and 7 d, 14 d of treatment respectively.Result:(1) There was significant difference in the level of CD3+, CD4+, CD8+, CD4+/CD8+ in this two groups at different time points, and that the level of CD3+, CD4+, CD4+/CD8+: T2>T1>T0, CD8+ level: T2<T1<T0;The increasing range of CD3+, CD4+, CD4+/CD8+level and the decreasing range of CD8+ in the observation group were larger than that in the control group, there was statistical significant difference. (2) The level of serum inflammatory factors CRP, IL-6, IL-1, TNF-α in two groups at different time points were statistical significant difference, all the CRP, IL-6, IL-1 and TNF-α level were T2<T1<T0, presenting a downward trend;The descending range of serum CRP, IL-6, IL-1, TNF-α level in the observation was larger compared with the control group, there was significant difference.Conclusion:The adjuvant antibiotic therapy through Xuebijing combined with thymopentin in elderly patients with severe pneumonia could improve the immune function and lower the inflammatory factors level.

急诊老年重症病毒性肺炎患者临床特征与住院死亡危险因素预测分析

目的:探讨急诊科老年重症病毒性肺炎(severe viral pneumonia,SVP)患者的临床特征和住院死亡的危险因素。方法:收集2023年12月7日至31日,北京安贞医院急诊科首次接诊的老年SVP患者的病历资料,比较生存组和死亡组的临床特征、实验室检查、治疗方案和并发症。采用多因素Logistic回归探讨与住院死亡相关的危险预测因素并通过ROC曲线评估危险因素的预测效能。结果:共纳入132例患者,生存组53例,死亡组79例,中位年龄81.0(75.0,86.0)岁,住院病死率为59.8%。85.6%的患者至少合并一种基础疾病,其中高血压最常见(67.5%),其次为慢性心脏疾病(50.8%)和2型糖尿病(40.9%)。多因素Logistic回归显示,就诊时床旁快速序贯性器官功能衰竭(quick sequential organ failure assessment,qSOFA)≥2、I型呼吸衰竭和hs-CRP升高,以及就诊2~3d仍存在I型呼吸衰竭、hs-TNI和D二聚体持续增高是老年SVP患者住院死亡的危险因素。ROC曲线下面积分别为0.774和0.786。结论:qSOFA≥2分、I型呼吸衰竭、hs-CRP升高、以及hs-TNI与D二聚体持续增高可作为早期识别老年高危SVP患者的危险预测因子,值得急诊医护人员在对患者进行分级管理时加以警惕。

老年重症肺炎抗生素降阶梯治疗及比阿培南的应用

目的:评价降阶梯治疗策略治疗老年重症肺炎的疗效。方法:回顾分析2008年1月—2011年1月解放军成都军区总医院老年科重症肺炎患者42例,分为治疗组(降阶梯治疗组,21例)和对照组(传统治疗组,21例),比较2组的不适当抗生素治疗发生率、临床疗效、细菌清除率、感染控制天数、住院费用等指标。结果:治疗组与对照组比较总有效率分别为90.48%(19/21)、61.90%(13/21);细菌清除率分别为82.60%(19/23)、59.09%(13/22);感染控制天数分别为(8.5±4.8)、(13.3±6.4)d,2组比较差异显著,有统计学意义(P<0.05);不适当抗生素治疗发生率和住院费用明显低于对照组,差异显著,有统计学意义(P<0.01)。结论:抗生素降阶梯疗法能迅速控制感染,提高治愈率,对老年重症肺炎可获得良好疗效。

心肌肌钙蛋白T和CK在老年重症肺炎患者中的临床意义及对预后的影响

目的探讨血清心肌肌钙蛋白T（cTnT）和CK在老年重症肺炎患者中的临床意义及对预后的影响。方法观察181例老年重症肺炎患者入院后3d内最高cTnT、CK测值和APACHEII评分，并对3者进行相关性分析。将患者分为cTnT正常组和升高组，比较两组的APACHEII评分和病死率。依据预后分为生存组和死亡组，比较两组cTnT、CK测值的变化。结果cTnT正常组APACHEII评分和死亡例数与升高组差异有统计学意义（P〈005）。生存组cTnT、CK测值和APACHEII评分与死亡组差异均有统计学意义（均P〈0．01），cTnT、CK与APACHEII评分3者之间呈正相关（均P〈0.01）。生存组cTnT、CK和APACHEII评分为（0．056±0．023）ng／ml、（13567±2071）μg／L和（17．4±2．8）分；死亡组cTnT、CK和APACHEII评分为（0．92±0.035）ng／ml、（210．22±32．6）μg／L和（24．8±5．6）分。结论老年重症患者cTnT、CK升高较常见，cTnT、CK监测对判断老年重症肺炎的预后具有一定临床意义。

ICU重症患者呼吸机相关性肺炎的护理体会

目的观察护理干预对ICU重症患者呼吸机相关性肺炎发生的影响。方法选取我院ICU重症患者64例(2017年3月—2018年4月),随机分为常规护理的对照组(32例)与综合护理的观察组(32例),观察患者相关指标及呼吸机相关性肺炎发生率。结果观察组机械通气时间(10.32±2.46)d,住院时间(16.49±2.67)d,呼吸机相关性肺炎发生率6.25%,对照组机械通气时间(16.43±2.81)d,住院时间(26.74±15.98)d,呼吸机相关性肺炎发生率28.13%,观察组机械通气时间、住院时间比对照组短,呼吸机相关性肺炎发生率比对照组低,P <0.05。结论给予ICU重症患者综合护理,能有效减少患者机械通气时间及住院时间,降低呼吸机相关性肺炎发生率,效果较好。

老年重症肺炎住院失眠患者实施护理干预的效果

目的:探究在老年重症肺炎住院并发生失眠情况的患者中将护理干预进行应用的主要效果。方法:选取2018年9月至2019年9月福建省立医院收治的老年重症肺炎患者98例作为研究对象,按照随机数字表发分为对照组和观察组,每组49例,分别给予患者常规护理干预和针对性睡眠护理干预,比较2组老年重症肺炎住院失眠患者的临床症状改善情况。结果:观察组患者的睡眠时间为(6.34±2.11) h,入睡潜伏期为(16.45±5.44) min,而对照组患者的睡眠时间则为(4.33±2.00) h,入睡潜伏期为(25.44±6.05) min,比较之下,对照组的睡眠质量低于观察组,数据有显著差别,结论:在老年重症肺炎住院失眠患者中针对性睡眠护理干预进行应用,其干预效果显著,可将患者的失眠症状进行改善,值得临床推广使用。

胸腺肽α1对老年重症医院获得性肺炎患者免疫功能的影响

目的:探讨胸腺肽α1治疗对老年重症医院获得性肺炎(SHAP)患者细胞免疫功能的影响及其临床意义。方法:48例SHAP患者随机分为治疗组和对照组。治疗组在对照组基础上给予胸腺肽α1 1.6 mg皮下注射,qd,持续1周,之后改为1.6 mg,皮下注射,隔日一次,共2周。结果:治疗组治疗后单核细胞人类白细胞抗原(HLA-DR)、自然杀伤(NK)细胞、CD4+细胞及CD4+/CD8+比值明显上升;治疗组住院死亡率明显低于对照组,其存活者抗生素应用时间亦比对照组明显缩短。结论:胸腺肽α1能提高SHAP患者免疫功能,有利于感染控制,并降低住院死亡率。

替考拉宁治疗老年重症革兰阳性菌肺炎临床疗效评估

目的探讨3种糖肽类抗菌药物治疗老年重症肺炎患者疗效及安全性。方法采用随机对照及开放性试验,82例革兰阳性菌感染的老年重症肺炎患者,随机分为两组,分别给予国产和进口替考拉宁治疗,替考拉宁针剂前3d用0.4g,1次/12h,以后为0.4g,1次/d,静脉滴注21d;对照组年轻重症肺炎患者30例,给予去甲万古霉素治疗,0.8g静脉滴注,14d。结果 3组患者临床有效率、痊愈率、细菌清除率国产替考拉宁组分别为85.7%、57.1%、95.2%;进口替考拉宁组分别为85.0%、57.5%、97.5%,去甲万古霉素组为86.7%、60.0%、90.0%,组间差异无统计学意义;不良反应发生率分别为4.8%、5.0%、53.3%,差异有统计学意义(P<0.05)。结论 3种糖肽类药物治疗革兰阳性球菌重症肺炎均有良好疗效,但替考拉宁不良反应明显低于去甲万古霉素,国产及进口均是老年革兰阳性菌重症肺炎患者的良好选择。