社区获得性肺炎诊断和治疗指南临床应用调查及490例病例分析  

Questionnaire survey of guideline implementation for community acquired pneumonia with retrospective analysis of the empiric treatment in 490 patients

作　　者：徐作军[1] 丁可[1] 黄慧[2] 孙铁英[3] 柯会星[3] 童朝辉[4] 危天倪[5] 彭堃[5] 姚彬[6] 李凤仙[7] 刘建华[7] 

机构地区：[1]北京首都医科大学附属朝阳医院 [2]中国医学科学院中国协和医科大学北京协和医院呼吸内科,100730 [3]北京医院 [4]北京首都医科大学附属朝阳医院-北京呼吸疾病研究所 [5]北京市第六医院 [6]北京市海淀医院 [7]北京怀柔区第一医院

出　　处：《中华结核和呼吸杂志》2007年第6期442-446,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：中华医学会呼吸病学分会感染学组中国下呼吸道感染优化治疗协作组科研基金

摘　　要：目的了解临床医师对社区获得性肺炎诊断和治疗指南(简称指南)的认识、执行情况以及是否按照指南诊治对预后的影响。方法在北京6家医院的医生中进行对指南的认识以及实施情况的问卷调查,同时回顾性分析2002年1月1日至2003年12月31日北京5家医院因社区获得性肺炎(CAP)住院的490例患者的资料,结合指南对其经验性治疗及转归进行分析。结果发放问卷250份,收回224份,回收率为89.6%,有效问卷210份。除了肺炎链球菌,大多数医生对其他病原体,特别是非典型病原体在 CAP 中的地位认识很局限。被调查的呼吸科医生中按照中华医学会呼吸病学分会制定的指南进行诊治的仅占46.0%(97/210)。82.4%(173/210)的医生根据具体情况有选择地给予初始经验性用药。79.5%(167/210)的医生常规进行病原学检查,84.3%(177/210)的医生认为病原学检查对选用抗生素很有帮助。被调查的490例病例中,非典型病原体感染占6.7%(33/490)。初始经验性治疗总有效率为84.5%(414/490),与中华医学会呼吸病学分会指南和美国胸科学会(ATS)指南所建议的初始治疗方案相符合的病例分别占46.7%(229/490)和26.7%(131/490)。按照指南治疗和不按照指南治疗的有效率比较无明显区别。依据病原学治疗与不依据病原学治疗的治愈率没有明显区别。结论真正按照中华医学会呼吸病学分会指南进行分组治疗的患者所占比例较小,然而绝大多数患者治愈,按照与不按照指南治疗的有效率没有明显区别;抗生素有过度应用之嫌,需要进一步推进指南的应用。Objective To assess physicians＇ awareness and use of guidelines for communityacquired pneumonia （CAP） published by Chinese Society of Respiratory Diseases （CSRD） and American Thoracic Society （ATS）, and to investigate influences of the guidelines on the prognosis of patients with CAP. Method A total of 210 self-completion questionnaires about CAP guidelines were received from doctors of six hospitals in Beijing. In addition, 490 serial cases of CAP collected from these hospitals admitted from January 2002 to December 2003 were retrospectively analyzed. Results Most doctors had limited knowledge about atypical pathogens. For pulmonary physicians, only 46% （97/210） reported using the CSRD guidehne. 82. 4% of the doctors preferred to give initial empiric antibiotic therapy according to the patients＇ conditions. 79. 5% （167/210） of the doctors ordered examination of the pathogens routinely and 84. 3% （177/210） of them admitted its usefulness for choosing antibiotics. 84. 5% （414/490） of the patients responded well to the initial empiric treatment. Patients who were treated according to the guidelines of CSRD and ATS were 229 cases and 131 cases respectively. There was no significant difference in the prognosis between patients who were treated according to the guideline and those who were not. There was no significant difference in the prognosis between cases with definite pathogens and cases without. Conclusions The results indicate low levels of awareness and use of guidelines for the management of CAP. Fewer than half of the patients were treated according to the guidelines. However, the treatments were effective in most of the patients, and there was no significant difference in the prognosis between patients who were treated according to the guideline and those who were not, because broad-spectrum antibiotics were overused. More effective guideline implementation strategies are needed to encourage compliance with practice guidelines for the management of CAP.

关 键 词：肺炎 指南 数据收集 经验性治疗 

分 类 号：R563.1[医药卫生—呼吸系统]