發(fā)布時(shí)間：2018-10-31 10:39

【摘要】：目的 探討社區(qū)獲得性肺炎(CAP)入院后48小時(shí)和72小時(shí)評估達(dá)到臨床穩(wěn)定的患者比例,研究天津地區(qū)影響CAP患者達(dá)到臨床穩(wěn)定的相關(guān)因素；分析影響CAP患者入院后抗生素調(diào)整及預(yù)后的相關(guān)因素；調(diào)查社區(qū)獲得性肺炎遵循指南選擇抗生素使用情況。 方法 收集天津地區(qū)10所醫(yī)院在2010年3月至2011年6月期間的收治的所有CAP病例,記錄CAP患者達(dá)到臨床穩(wěn)定性的時(shí)間,并分析患者的年齡、性別、基礎(chǔ)疾病、CURB評分、入院前、后使用抗生素與臨床穩(wěn)定的關(guān)系；分析CAP患者年齡、性別、基礎(chǔ)疾病、CURB評分、入院前、后使用抗生素與患者入院后抗生素方案調(diào)整及預(yù)后的關(guān)系。 結(jié)果 1)在701例CAP患者中,有394例患者在入院后72小時(shí)達(dá)到臨床穩(wěn)定,占總患者比例的56.2%,其中有183例患者在入院后48小時(shí)達(dá)到臨床穩(wěn)定,占總患者比例的26.2%,影響48小時(shí)達(dá)到臨床穩(wěn)定的相關(guān)因素有：年齡、合并基礎(chǔ)疾病(合并COPD、冠心病)、CURB評分。 2)CAP患者入院后抗菌藥物使用率為100.0%,CAP患者入院后初始治療抗生素的選擇比例依次為：單用β內(nèi)酰胺類(23.4%)、β內(nèi)酰胺類+大環(huán)內(nèi)酯類(17.9%),單用莫西沙星(13.6%)、單用左氧氟沙星(12.4%),單用大環(huán)內(nèi)酯類(8.9%)、β內(nèi)酰胺類+喹諾酮類(7.8%)、β內(nèi)酰胺類+氨基糖苷類(6.4%)、其它(9.2%)。入院后抗生素選擇使用莫西沙星的CAP患者72小時(shí)后抗生素方案調(diào)整率低于β-內(nèi)酰胺類+大環(huán)內(nèi)酯類,差別具有統(tǒng)計(jì)學(xué)意義。 3)CAP患者預(yù)后僅顯示與年齡有關(guān),年齡越高,治療效果越差；與CAP患者的性別、合并基礎(chǔ)疾病與否、CURB評分及入院后選擇使用不同種類的抗生素?zé)o關(guān),差別不具有統(tǒng)計(jì)學(xué)意義。 4)在701例CAP患者中,427例CAP患者符合入院標(biāo)準(zhǔn),占所有入院患者的67.4%,入院后遵循指南選擇抗生素的CAP患者有309例,所占比例為43.9%。 結(jié)論 1)研究顯示,超過一半CAP患者在72小時(shí)內(nèi)達(dá)到臨床穩(wěn)定,影響臨床穩(wěn)定的相關(guān)因素有：年齡、合并基礎(chǔ)疾病(合并COPD、冠心病)、CURB評分。 2)莫西沙星的72小時(shí)后抗生素方案調(diào)整率低于β-內(nèi)酰胺類+大環(huán)內(nèi)酯類,CAP患者預(yù)后僅顯示與年齡有關(guān),年齡越高,治療效果越差。 3)部分CAP患者入院標(biāo)準(zhǔn)及入院后抗生素選擇不符合指南要求,有待進(jìn)一步規(guī)范。
[Abstract]:Objective to investigate the proportion of patients with community-acquired pneumonia (CAP) who achieved clinical stability 48 hours and 72 hours after admission, and to study the related factors that affect the clinical stability of CAP patients in Tianjin area. To analyze the related factors of antibiotic adjustment and prognosis after admission in CAP patients and investigate the use of antibiotics according to the guidelines of community acquired pneumonia. Methods all cases of CAP were collected from 10 hospitals in Tianjin from March 2010 to June 2011. The time of clinical stability of CAP patients was recorded, and the age, sex, basic disease and CURB score were analyzed. The relationship between antibiotic use and clinical stability before and after admission; To analyze the relationship between age, sex, basic disease, CURB score, antibiotic use before and after admission and the adjustment of antibiotic regimen and prognosis in patients with CAP. Results 1) among 701 patients with CAP, 394 patients reached clinical stability at 72 hours after admission, accounting for 56.2 percent of the total number of patients, and 183 patients reached clinical stability 48 hours after admission. The related factors affecting clinical stability in 48 hours were age and basic disease (), CURB score of COPD, coronary heart disease). 2) the antibiotic utilization rate of CAP patients was 100.0%. The selection rate of antibiotics in the initial treatment was: 尾 lactam alone (23.4%), 尾 lactam macrolides (17.9%), 尾 lactam group (17.9%), 尾 lactam group (23.4%), 尾 lactam group (17.9%), and 尾 lactam group (17.9%). Moxifloxacin alone (13.6%), levofloxacin (12.4%), macrolides (8.9%), 尾 lactams (7.8%), 尾 lactams (6.4%), 尾 lactams (6.4%), Others (9.2%). The adjustment rate of antibiotic regimen in CAP patients who were treated with moxifloxacin 72 hours after admission was lower than that of 尾-lactam macrolides, and the difference was statistically significant. 3) the prognosis of CAP patients was only related to age. The higher the age, the worse the therapeutic effect. There was no significant difference in the sex of CAP patients, the combination of underlying diseases or not, the CURB score and the choice of different kinds of antibiotics after admission. 4) of the 701 patients with CAP, 427 patients with CAP met the admission criteria, accounting for 67.4 percent of all the hospitalized patients. 309 patients with CAP followed the guidelines to select antibiotics after admission, accounting for 43.9 percent. Conclusion 1) the study showed that more than half of CAP patients reached clinical stability within 72 hours. The related factors influencing clinical stability were age and basic disease (), CURB score of COPD, coronary heart disease). 2) after 72 hours of moxifloxacin, the adjustment rate of antibiotic regimen was lower than that of 尾 -lactam macrolides. The prognosis of patients with CAP was only related to age. The higher the age, the worse the therapeutic effect. 3) the admission criteria and antibiotic selection of some CAP patients do not meet the requirements of the guidelines and need to be further standardized.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R563.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前7條

1 蘇欣;施毅;宋勇;;社區(qū)獲得性肺炎臨床診斷治療進(jìn)展[J];中國呼吸與危重監(jiān)護(hù)雜志;2006年03期

2 梅建華;周云芳;吳正春;呂祝慶;;阿齊霉素聯(lián)合頭孢噻肟鈉治療老年社區(qū)獲得性肺炎[J];中國微生態(tài)學(xué)雜志;2007年02期

3 譚星宇 ,何權(quán)瀛 ,趙學(xué)紅 ,王月珠;社區(qū)獲得性肺炎平均住院日影響因素分析[J];中國衛(wèi)生統(tǒng)計(jì);2002年04期

4 劉又寧;陳民鈞;趙鐵梅;王輝;王睿;劉慶鋒;蔡柏薔;曹彬;孫鐵英;胡云建;修清玉;周新;丁星;楊嵐;卓建生;唐英春;張扣興;梁德榮;呂曉菊;李勝歧;劉勇;俞云松;魏澤慶;應(yīng)可凈;趙峰;陳萍;侯曉娜;;中國城市成人社區(qū)獲得性肺炎665例病原學(xué)多中心調(diào)查[J];中華結(jié)核和呼吸雜志;2006年01期

5 胡云建,張秀珍;非典型病原體引起下呼吸道感染的調(diào)查[J];中華醫(yī)院感染學(xué)雜志;2002年08期

6 杜娟;高占成;;社區(qū)獲得性肺炎255例治療與國內(nèi)外指南推薦方案對比研究[J];中國實(shí)用內(nèi)科雜志;2006年03期

7 ;社區(qū)獲得性肺炎診斷和治療指南[J];中華結(jié)核和呼吸雜志;2006年10期

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