临床肺部感染评分对临床诊断医院获得性下呼吸道感染患者抗菌药物使用的影响  

An Evaluation of Clinical Pulmonary Infection Score on the Course of Antimicrobial Therapy in Patients with Clinical Suspected Hospital Acquired Lower Respiratory Tract Infection

作　　者：陈旭岩[1] 李晓晶[1] 于净[1] 简忠[1] 冯莉莉[1] 

机构地区：[1]北京大学第一医院急诊科,100034

出　　处：《中国全科医学》2007年第5期367-369,共3页Chinese General Practice

摘　　要：目的探讨临床肺部感染评分(CPIS)对急诊重症监护病房(EICU)临床诊断(疑诊)医院获得性下呼吸道感染(HALRTI)患者抗菌药物使用的影响。方法采用随机、对照、开放、临床研究。连续入选北京大学第一医院EICU有肺部浸润、医生疑诊HALRTI已经使用或准备使用抗菌药物、并符合排除标准,且入选当日CPIS<6分的患者81例,随机分为两组:A组(评分组,39例)继续或开始使用抗菌药物3d,每天计算CPIS,若持续CPIS<6分,第4d停用抗菌药物;B组(常规组,42例)按照常规由查房医生自然决定抗菌药物的选择和疗程。比较两组患者抗菌药使用疗程、平均EICU停留时间和病死率及真菌定植发生率。统计转出EICU时主要临床诊断。结果A组抗菌药物使用疗程显著低于B组,差异有显著性意义(P<0.001);两组EICU停留时间和病死率间差异无显著性意义(P>0.05);B组真菌定植发生率高于A组,差异有显著性意义(P<0.05)。前3位主要临床诊断是肺炎、急性肺水肿和COPD院内急性加重。结论CPIS评分有助于缩短EICU患者抗菌药物的使用疗程,降低真菌感染的发生,并且不增加其他临床风险。Objective To observe the efficacy of clinical pulmonary infection score （CPIS） to the course of antimierobial therapy in patients with elinieally suspeeted hospital aequired lower respiratory traet infeetion（HALRTI） in the Emergeney Intensive Care Unit （EICU）. Methods A randomized, open, eontrolled elinieal trial was taken. Totally 81 patients in EICU who being elinieally diagnosed as having HALRTI and receiving antibioties （ATB） were enrolled as their CPIS 〈 6 at the enrolling day. The 39 subjects in group A eontinued using ATB for 3d, and their CPIS was calculated eaeh day, and ATB was stopped when the CPIS remained 〈 6 at the 4th day. The 42 subjeets in group B reeeived the standard antimierobial therapy, ehoiee and duration of ATB at the diseretion of physieians. Results The duration of antimierobial therapy in group A was signifieantly shorter than that eontrolled group （ P 〈0. 001 ）. There were significant differenees in mortality and duration of EICU stay between two groups. The ineidenee of fungus eolonization was higher in group B than that in group A （ P 〈 0.05 ）. The first three elinieally diagnosed diseases were pneumonia, aeute pneumoedema and hospital aequired aeute deteriorated COPD. Conclusion CPIS was helpful to shorten the antimierobial therapy eourse in EICU patients when elinically diagnosed as having HALRTI; and it may reduee the ineidenee of fungus infeetion.

关 键 词：临床肺部感染评分 医院感染 下呼吸道感染 临床诊断 抗菌药物 疗程 

分 类 号：R562[医药卫生—呼吸系统] R978.1[医药卫生—内科学]