贵阳地区社区获得性肺炎诊治现状与中国指南对比研究  

Community- acquired Pneumonia in Guiyang: A Comparative Study of Its Diagnosis/Treatment According to Chinese Guidelines

作　　者：张先明 唐凤婕 杜丹[1] 杜娟[1] 

机构地区：[1]贵阳医学院附属医院呼吸内科,贵州省贵阳市550004

出　　处：《中国全科医学》2015年第5期521-524,共4页Chinese General Practice

基　　金：贵州省优秀科技教育人才省长专项资金项目【黔省专合字(2008)90号】

摘　　要：目的调查贵阳地区三甲医院对社区获得性肺炎(CAP)的诊治现状,并与《社区获得性肺炎诊断和治疗指南》(以下简称中国指南)推荐的治疗对比,为CAP的诊治提供依据。方法选择2012年1—12月在贵阳地区5所三甲医院(贵阳医学院附属医院、贵阳市第一人民医院、贵阳市肺科医院、贵阳中医学院第二附属医院、贵州省第二人民医院)呼吸内科住院并符合中国指南诊断标准的CAP患者496例,将患者按照中国指南病情评估方法进行分组,分为应门诊治疗组83例、住院治疗组375例和重症肺炎组38例。分析3组患者一般资料及致病原检测、抗菌药物使用情况。并按照PSI评分方法对患者进行分级,分析中国指南CAP评估方法与PSI评分间的相关性。结果 3组患者年龄、住院时间、抗菌药物使用时间、机械通气率、好转和治愈率、病死率比较,差异均有统计学意义(P<0.05);3组患者序贯治疗率比较,差异无统计学意义(P>0.05)。496例CAP患者中278例(56.0%)进行痰培养检查,痰培养阳性率为52.1%(145/278)。检出率最高的是肺炎链球菌11.5%(32/278);支原体Ig G抗体检测率为21.8%(108/496),阳性率为19.4%(21/108)。3组患者1种抗菌药物使用率、2种抗菌药物使用率比较,差异均无统计学意义(P>0.05);3组患者3种抗菌药物使用率比较,差异有统计学意义(P<0.05),其中住院治疗组和重症肺炎组3种抗菌药物使用率比较,差异无统计学意义(P>0.05)。3组患者大环内酯、氟喹诺酮、头霉素、半合成青霉素、一代头孢、二代头孢、三代头孢使用率比较,差异均无统计学意义(P>0.05);3组患者碳氢霉烯、糖肽类使用率比较,差异有统计学意义(P<0.05)。Spearman分析结果显示,中国指南病情评估标准与PSI评分分级间具有相关性(rs=0.507,P<0.001)。结论贵阳地区CAP诊治现状与中国指南尚存在一定差异,需要继续加强对指南的依从性;且中国指南病情评估�Objective To investigate the status quo of diagnosis/treatment of community- acquired pneumonia（ CAP） in top three hospitals in Guiyang,and compared with Guideline of Diagnosis and Treatment of Community- acquired Pneumonia（ Chinese guidelines）,to provide references for its diagnosis and treatment. Methods From January to December2012,in 5 top three hospitals in Guiyang,496 CAP patients in line with the diagnostic criteria of Chinese guidelines were divided,according to the disease assessment methods of Chinese guidelines, into groups A（ who should be given outpatient treatment,n = 83）, B（ who should be hospitalized, n = 375）, C（ with severe pneumonia, n = 38）. The general information,pathogenic strain detection,uses of antibacterial agents were analyzed. The PSI scoring method was used to grade the patients. The correlation between CAP evaluating method of Chinese guidelines and PSI scoring was analyzed. Results There was significant difference in age,hospital stay,time of antimicrobial drug use,rate of mechanical ventilation,rates of improvement and cure,mortality among 3 groups（ P〈0. 05）,but there was not in sequential therapy（ P〈0. 05）. In 496 CAP patients,278（ 56. 0%） had sputum culture examinations with a positive rate of 52. 1%（ 145 /278）. The top detection rate was that of streptococcus pneumoniae（ 11. 5%,32 /278）; the detection rate of mycoplasma Ig G antibodies was 21. 8%（ 108 /278） with a positive rate of 19. 4%（ 21 /108）. There was no difference in usage rates of 1,2 kinds of antibiotics（ P〈0. 05）,there was in usage rate of 3 kinds of antibiotics among 3 groups（ P〈0. 05）,but there was no difference between groups B,C（ P〈0. 05）. There was no difference in usage rates of macrolide, fluoroquinolone, cephamycin, semi- synthetic penicillins,generation Ⅰ,Ⅱ,Ⅲ cephalosporin（ P〈0. 05）,there was in those of hydrocarbon alkene,glycopeptides（ P〈0. 05）. Spearman analysis showed that the diagnostic criteria of Chinese guidelines

关 键 词：社区获得性肺炎 PSI评分 抗菌药 指南 

分 类 号：R563.1[医药卫生—呼吸系统]