量化感染与抗菌策略对慢性阻塞性肺病急性发作患者预后的影响  

Influence of grading infection and antimicrobial strategy on the clinical outcome of patients with chronic obstructive pulmonary disease at acute stage

作　　者：刘励军[1] 徐信发[1] 余世全[1] 沈斌[1] Sauder P 

机构地区：[1]苏州大学第二附属医院ICU,江苏苏州215004 [2]法国斯特拉斯堡市路易.巴士德大学附属民众医院ICU

出　　处：《中国急救医学》2002年第9期519-520,共2页Chinese Journal of Critical Care Medicine

摘　　要：目的　试图找出针对慢性阻塞性肺病 (COPD)急性发作患者合适的抗菌治疗策略。方法　根据SepsisScore(SS)评分 ,对 4 7例接受过NIPPV治疗的COPD急性发作患者进行肺部感染严重度的评分 ,并依据治疗效果和支气管—肺泡灌洗液细菌学检测结果评价抗菌治疗是否充分 ,以及对临床转归的影响。结果　监测COPD急性发作期患者的SS ,发现当SS≤10时 ,充分的经验性抗菌治疗可明显降低死亡率 ;但是 ,当SS积分 >10时 ,抗菌治疗策略并不能明显改善患者的预后。结论　根据COPD急性发作患者感染严重度 ,早期采取相应抗菌治疗策略 。Objective To find out the appropriate antimicrobial treatment strategy for the COPD patients at acute stage. Methods By grading lung infection degree of 47 patients with COPD at acute stage who have initially received NIPPV treatment, and also according to the microbial investigation of the samples of BAL fluid. The study evaluates the antimicrobial treatment of infection and its influence on clinical outcome. Result Monitoring the grading of pulmonary infection of patients with COPD at acute stage, it is found that adequate empiric antimicrobial treatment of infection will significantly reduce the hospital mortality, when the patients' SS≤10 but if their SS>10 anti-microbial treatment will not improve the patients' prognosis. Conclusion According to the grading of infection, taking early and appropriate antimicrobial treatment of infection may reduce mortality of COPD patients at acute stage, and prevent the abuse of antibiotics.

关 键 词：慢性阻塞性肺病 急性发作 量化感染 抗菌策略 预后 COPD 血气分析 支气管-肺泡灌洗术 

分 类 号：R563.9[医药卫生—呼吸系统]