某三甲医院重症社区获得性肺炎治疗现状分析  

Analysis of current status of treatment for severe community-acquired pneumonia in a third-grade class A hospital

作　　者：林晓红 李鸿茹[2,3] 陈愉生[2,3] 林丹 陈诗杰[2] 谢剑峰 Lin Xiaohong;Li Hongru;Chen Yusheng;Lin Dan;Chen Shijie;Xie Jiefeng(Department of Internal Medicine,Fujian Provincial Jinshan Hospital,Fuzhou 350001,China;Department of Respiratory and Critical Care Medicine,Fujian Provincial Hospital,Fuzhou 350001,China;Research Section,Four Respiratory Diseases of Fujian Province,Fuzhou 350001,China;Fujian Provincial Center for Disease Control and Prevention,Fuzhou 350001,China)

机构地区：[1]福建省立金山医院内科,福建福州350001 [2]福建省立医院呼吸与危重症医学科,福建福州350001 [3]福建省呼吸四病研究室,福建福州350001 [4]福建省疾病与预防控制中心,福建福州350001

出　　处：《临床荟萃》2019年第2期132-135,共4页Clinical Focus

基　　金：国家"十三五"科技支撑计划项目--急性呼吸道传染病原谱和流行规律及重要病原变异变迁(2017ZX10103004);福建省医学创新联合基金--重症社区获得性肺炎床边病原快速诊断系统的建立(2016Y9005)

摘　　要：目的通过回顾性分析福建省立医院重症社区获得性肺炎(severe community acquired pneumonia,SCAP)治疗现状。方法收集福建省立医院2012年4月至2015年12月的SCAP患者88例,对其治疗现状及呼吸支持方式进行分析。高通量检测技术筛查36种病原,并分为病毒组、细菌组、混合感染组、阴性组,分析不同组治疗现状差异。结果 88例SCAP患者中大包围治疗占4.5%,使用1种抗生素的占18.18%,2种占42.05%,3种及以上占39.78%,抗生素类别中以β内酰胺类最为突出(87.5%),喹诺酮类使用率53.41%,抗耐甲氧西林金黄色葡萄球菌(MRSA)药物使用率37.5%,而抗病毒率为26.1%。病毒组、细菌组、混合感染组、阴性组中使用3种以上抗生素的均达到40%左右。混合感染组患者更易使用抗MRSA药物(P<0.05)。SCAP患者以无创机械通气为主(63.6%),单纯氧疗占27.3%,有创机械通气9.09%。结论本院SCAP的抗菌治疗还存在着不同程度的盲目性,亟需早期病原诊断以指导临床针对性抗菌治疗,重症肺炎的辅助通气主要以无创通气为主。Objective To retrospectively analyze the current status of severe community-acquired pneumonia(SCAP)in Fujian Provincial Hospital.Methods A total of 88 SCAP patients with community-acquired pneumonia from April 2012 to December 2015 was collected to analyze the current status of drug treatment and respiratory support modes.The treatment of four different etiology groups(including viral,bacterial,combined infection group,and negative group)was compared after the pathogens were detected by high-throughput technology.Results Among the 88 patients with SCAP,the use of extensive treatment accounted for 4.5%,18.18%(16/88)of which received 1 antibiotic treatment,42.05%(37/88)of which received two kinds of antibiotics,39.78%(35/88)of which received no less than 3 categories.Of all the used antibiotics,β-lactams were mostly widely used(87.5%),quinolones were 53.41%,and methicillin-resistant Staphylococcus aureus(MRSA)was 37.5%,while the antiviral rate was 26.1%.About 40%of cases used more than 3 kinds of antibiotics in four groups.Patients with combined infection were more likely to use anti-MRSA drugs(P<0.05).Non-invasive mechanical ventilation(63.6%)was performed in SCAP patients,27.3%in simple oxygen therapy,and 9.09%in invasive mechanical ventilation.Conclusion The antimicrobial treatment of SCAP in our hospital also has different degree of blindness.It is urgent to diagnose early pathogens to guide clinical targeted antimicrobial therapy.The main auxiliary ventilation for severe pneumonia is noninvasive ventilation.

关 键 词：社区获得性感染 肺炎 药物疗法 呼吸支持模式 

分 类 号：R51[医药卫生—内科学]