我国社区获得性肺炎诊治情况的调查  

Diagnosis and treatment of community acquired pneumonia in China: a survey of current situation

作　　者：周敏[1] 邓伟吾[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院呼吸科,200025

出　　处：《上海医学》2007年第5期323-325,共3页Shanghai Medical Journal

摘　　要：目的了解我国社区获得性肺炎(CAP)的诊断、治疗现状。方法调查7个城市767名来自不同专业的临床医师,采用问卷调查的形式获取信息。结果43%(329／767名)的医师根据病史、体征、血常规及胸部X线检查诊断CAP,21％(161／767名)的医师认为需要结合血清学结果,20％(153／767名)的医师还认为痰液培养检查是诊断所必需的。90％(43／48所)的医院可以进行细菌学检查,大部分医院可进行非典型致病菌的检查,54% (26／48所)的医院能检测病毒。51％(391／767名)的医师根据治疗指南选择抗生素,42%(322／767名)的医师根据个人经验选用。门诊治疗中,68％(522／767名)的医师选择口服抗生素,26％(199／767名)的医师选择静脉应用抗生素,其中80%(159／199名)的医师实施了序贯治疗的原则。分别有54％(414／767名)和40％(307／767名)的医师不了解美国胸科学会和中华医学会呼吸病学分会制定的相关指南。结论CAP的病原学检测尤其是非典型致病菌和病毒的检测需要广泛开展;抗生素的使用尚需进一步规范,以避免医疗资源的浪费和耐药菌群的产生;CAP的诊疗指南需要普及并不断完善。Objective To survey the current situation of the diagnosis and treatment of community acquired pneumonia（CAP） in China. Methods Seven hundred and sixty-seven clinical doctors with different specialties from 7 cities were surveyed by questionnaire. Results Forty-three percent（329/767 cases） clinical doctors diagnosed CAP by history, physical signs, blood routine and X-ray of chest; twenty-one percent（ 161/767 cases） clinical doctors considered serologic examination necessary; twenty percent（153/767 cases） of them thought the sputum culture necessary. Sputum culture could be carried out in 90%（43/48） of the hospitals and atypical pathogen examination could be performed in most hospitals. Fifty-four percent（26/48） hospitals could perform virus detection. Fifty- one percent（391/767 cases） clinical doctors chose antibiotics according to the guideline, 42% （322/767 cases） selected antibiotics empirically. In outpatient department, 68% （522/767 cases） patients were treated by oral antibiotics and 26% （199/767 cases） by intravenous administration. Eighty percent（159/199 cases） doctors gave sequential therapy. Fifty-four percent（414/767 cases） and 40% （307/767 cases） doctors were not familiar with the guideline of American Thoracic Society（ATS） and Chinese Medical Association（CMA）. Conclusion The examination of pathogens, especially the atypical pathogens and virus in CAP should be widely used. The use of antibiotics should be more cautious to avoid the wastage of medical resources and generation of drug-resistant bacteria. The guideline of CAP should be completed and perfected. （Shanghai Med J, 2007, 30：323-325）

关 键 词：社区获得性肺炎 病原体 抗生素 指南 

分 类 号：R563.1[医药卫生—呼吸系统]