初始治疗对胸腔细菌感染患者临床转归的影响  

The Impacts of Initial Therapy on Clinical Outcome of Patients with Thoracic Bacterial Infection

作　　者：姜红妮[1] 汤敏[2] 刘洁[1] 瞿介明[3] Jiang Hongni Tang Min Liu Jie Qu fleming(Department of Respiratory Medicine, Zhongshan Hospital Affiliated to Fudan University, Shanghai, 200032, Chin)

机构地区：[1]复旦大学附属中山医院呼吸科,上海200032 [2]复旦大学附属中山医院放射科,上海200032 [3]上海交通大学附属瑞金医院呼吸科,上海200025

出　　处：《中国呼吸与危重监护杂志》2016年第6期552-556,共5页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：上海市科委西医引导类项目(编号:14411965900)

摘　　要：目的观察初始治疗是否充分对社区获得性胸腔细菌感染患者临床转归的影响。方法回顾性病例分析收集符合英国胸科医师协会胸腔细菌感染诊断标准的急性社区获得性胸腔感染患者,按是否给予充分的初始抗生素及胸腔积液引流联合治疗分为初始充分治疗组(31例)和初始未充分治疗组(17例),比较两组临床表现、炎症指标及住院天数和住院费用的差别。结果两组间年龄、性别、胸腔感染部位、伴发基础疾病等一般情况无统计学差异(P均>0.05)。初始充分治疗组体温较初始未充分治疗组下降更快,在治疗后第5、6、7 d与初始未充分治疗组比较,差异有统计学意义[(37.4±0.1)℃比(38.3±0.2)℃,P<0.001;(37.4±0.1)℃比(37.9±0.1)℃,P<0.05;(37.4±0.1)℃比(38.1±0.2)℃,P<0.01]。治疗后6周内,两组白细胞计数、中性粒细胞百分比及血沉的变化无明显差异(P均>0.05),初始充分治疗组在治疗第1周时C反应蛋白(CRP)较初始未充分治疗组显著降低[(123.1±13.8)mg/L比(182.7±25.3)mg/L,P<0.05]。初始充分治疗组较初始未充分治疗组住院花费显著减少[(28 367±3 328)元比(43 334±7 134)元,P<0.05],住院时间也显著缩短[(25±4)d比(34±4)d,P<0.05]。结论初始选择正确的抗生素并联合充分有效的胸液引流可以使患者体温及CRP更快地下降,从而降低住院花费、缩短住院时间。治疗5 d体温是否低于37.5℃以及CRP是否明显下降是评价初始治疗效果的敏感指标,有助于指导下一步治疗措施。Objective To observe the impacts of initial therapy on clinical outcome of patients with community-acquired thoracic infection by retrospective analysis. Methods Clinical data of acute community-acquired thoracic infection patients who met the British Thoracic Society diagnostic criteria were collected. The patients were divided into two groups according to whether adequate initial antibiotic therapy and pleural effusion drainage were performed,namely an adequate group（ 31 patients） and an inadequate group（ 17 patients）. Clinical manifestations,inflammatory markers,hospital stay and hospital costs were analyzed between the two groups. Results For age,gender,infection sites,and coincident diseases,there were no significant differences between the two groups. Compared with the inadequate group,temperature of the adequate group was significantly decreased,especially on hospital day 5,6,7 [（ 37. 4 ± 0. 1） ℃ vs.（ 38. 3 ± 0. 2） ℃,P 〈0. 001;（ 37. 4 ± 0. 1） ℃ vs.（ 37. 9 ± 0. 1） ℃,P〈0. 05;（ 37. 4 ± 0. 1） ℃ vs.（ 38. 1 ± 0. 2） ℃,P〈0. 01]. The level of serum C-reactive protein（ CRP） in first week was also significantly reduced in the adequate group [（ 123. 1 ± 13. 8） mg / L vs.（ 182. 7 ± 25. 3） mg / L,P〈0. 05].However,there were no differences in white cell counts, percentage of neutrophils, or erythrocyte sedimentation rate between the two groups in six-week follow-up. The adequate group had shorter hospitalstay [（ 25 ± 4） days vs.（ 34 ± 4） days,P〈0. 05] and lower hospital costs [（ 28 367 ± 3 328） yuan vs.（ 43 334 ± 7 134） yuan,P〈0. 05]compared with the inadequate group. Conclusions The initial therapy with appropriate antibiotics and effective thoracic drainage can significantly decrease the temperature and CRP of patients with thoracic infection,as well as the cost of hospitalization and the length of stay. Our study reveals that the temperature which is lower than 37. 5 ℃ on the 5th day of therapy and the CRP in the first fo

关 键 词：胸腔细菌感染 抗生素 胸腔引流 

分 类 号：R56[医药卫生—呼吸系统]