经验性抗感染治疗急诊病房社区获得性肺炎疗效评价  

Evaluation on efficacy of initial empirical antimicrobial therapy for patients with community acquired pneumonia in emergency ward

作　　者：陈庆青[1] 宋志芳[1] 

机构地区：[1]上海交通大学医学院附属新华医院崇明分院急危重症医学科,上海202150

出　　处：《中华肺部疾病杂志（电子版）》2012年第3期7-12,共6页Chinese Journal of Lung Diseases(Electronic Edition)

摘　　要：目的评价急诊病房经验性抗感染治疗社区获得性肺炎(CAP)的临床疗效。方法以急诊病房CAP患者为研究对象,依据低、中、高危人群前瞻性应用抗感染治疗方案(阿奇霉素或左氧氟沙星、或联合二、三、四代头孢),评价其疗效。结果 92例患者中,男63例(68.5%)/女29例(31.5%),年龄69.1±16.7(14～99)岁,其中CAP60例(65.2%),CAP伴胸膜炎18例(19.6%),慢性阻塞性肺疾病急性加重(AECOPD)伴CAP8例(8.7%),AECOPD合并CAP伴胸膜炎4例(4.4%),支气管扩张合并CAP2例(2.2%)。所有患者中,低危人群28例(30.4%),中危人群34例(37.0%),高危人群30例(32.6%)。在几种治疗方案中,7d好转率(有效/显效)为60.9%(56例)、临床治愈率为38.0%(35例),总有效率(好转+治愈)为98.9%(91例)。14d治愈率为47.8%(44例),21d治愈率为10.9%(10例)。结论依据低、中、高危人群单独选择阿奇霉素或左氧氟沙星、或联合二、三、四代头孢类抗菌药物,经验性抗感染治疗CAP疗效确切可靠。Objective TO evaluate the clinical efficacy of initial empirical antimicrobial therapy for patients with community acquired pneumonia（CAP） in the emergency ward. Methods Patients with CAP in the emergency ward were treated by several programs of empirical antimicrobial therapy （Azithromycin, Levofloxacin or combining two, three, four generations Cephalosporins ） prospectively according to high or low risk groups. Their clinical data were collected to evaluate and compare their efficacy. Results Totally there were 92 cases of patients with male/female 63 cases （68.5%）/29 cases（31. 5%）,age 69. 1 ± 16.7（14 to 99）years old. There were 60 cases （65.2%） with CAP, 18 cases（ 19.6% ） with CAP combining pleuritis,8 cases （8.7%） with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） combining CAP, 4 cases （4.4%） with AECOPD combining CAP and pleuritis; 2 cases （2. 2%） with bronchiectasis combining CAP. The low-risk group, moderate-risk group and high-risk group were 28 cases （30.4%）, 34 cases （37.0%） and 30 cases（32.6% ） respectively. For several programs 56 cases （60.9%） were improved and 35 cases （38.0%） were cured on the 7th days （7 d）. It means that the total effective rate was 98.9% （91/92cases）. The cured rate was 47.8% （44/92 cases）on the 14th days （14d） and 10.9% （10/92 cases）on the 21th days （21d）. Conclusion According to low- moderate- high risk groups, it would be effectively and reliably to treat CAP by empiric antiinfective treatment of macrolide antibiotic （azithromycin） or respiratory quinolone （levofloxacin）, or combine the various generations of cephalosporins.

关 键 词：肺炎 社区获得性 抗感染治疗 经验性 大环内酯类 左氧氟沙星 

分 类 号：R563[医药卫生—呼吸系统]