降阶梯抗生素方案治疗老年重症肺炎的临床观察  

Clinical Observation of Antibiotic De-escalation Therapy for the Elderly with Severe Pneumonia

作　　者：钱骏[1] 欧阳张宁[1] 漆波 Qian Jun;Ou Yang Zhangning;Qi Bo(Department of Critical Care Medicine,the People's Hospital of Jiangyou City,Sichuan Province,621700,P.R.China)

机构地区：[1]四川省江油市人民医院重症医学科

出　　处：《老年医学与保健》2019年第5期661-664,共4页Geriatrics & Health Care

摘　　要：目的观察降阶梯抗生素方案治疗重症监护室老年重症肺炎的临床效果,为治疗该病提供方法。方法回顾性分析2017年10月—2018年10月在我院重症监护病房住院的170例老年重症肺炎患者的临床资料,根据治疗方案的不同分为观察组和对照组,每组85例。观察组给予降阶梯抗生素治疗方案,对照组给予传统抗生素治疗方案,评估并比较2组疗效、临床指标和生化指标情况。结果治疗后观察组咳嗽消失时间、啰音消退时间、机械通气时间、感染控制时间、ICU入住时间、总住院时间均显著少于对照组(P<0.001),而住院费用低于对照组(P<0.001)。治疗前,2组血pH值、PaO2、PaCO2、CRP、PCT和D-二聚体水平差异均无统计学意义(P>0.05);治疗后,2组血pH值和PaO2水平均明显比同组治疗前升高(P<0.05),而PaCO2、CRP、PCT和D-二聚体水平均明显降低(P<0.05);观察组PaO2水平显著高于对照组(P<0.05),而PaCO2、CRP、PCT和D-二聚体水平均显著低于对照组(P<0.05)。观察组治疗有效率显著高于对照组(97.65%vs82.35%,P<0.05)。结论降阶梯抗生素方案治疗老年重症肺炎,疗效显著,能有效清除病灶,控制疾病进展,缩短住院时间,具有一定的临床应用价值。Objective To observe the clinical effect of antibiotic de-escalation therapy on the elderly with severe pneumonia in intensive care unit(ICU).Methods A retrospective analysis was made to the clinical data of 170 elderly with severe pneumonia in ICU during the period from Oct.,2017 to Oct.,2018;based on the therapy,the 170 elderly were divided into 2 groups:observation group and control group,85 in each;antibiotic de-escalation therapy was given to the elderly in observation while routine antibiotic therapy to the elderly in control group;a comparative study was made between the 2 groups in curative effect,clinical data and biochemical index.Results The fading time of coughing and rales,mechanical ventilation time,infection control time,ICUstay time and the whole hospitalization time were significantly shorter and the hospitalization expenses were lower in observation group than those in control group(P<0.001);before treatment,there were no significant differences in blood pH,PaO2,PaCO2,CRP,PCT and D-dimer levels between the 2 groups(P>0.05);the blood pH and PaO2 levels in the 2 groups were significantly higher and the levels of PaCO2,CRP,PCT and D-dimer were much lower after treatment than those before treatment(P>0.05);the level of PaO2 was much higher while the levels of PaCO2,CRP,PCT and D-dimer were much lower in observation group than those in control group(P<0.05);the curative effective rate in observation group was significantly higher than that in control group(97.65%vs 82.35%,P<0.05).Conclusion The antibiotic de-escalation therapy is of obvious effect on the elderly with severe pneumonia in ICU;it can remove the lesions,control the disease progression and shorten the hospitalization,worthy of certain clinical application value.

关 键 词：老年 肺炎 抗生素治疗 降阶梯方案 重症监护室 疗效 

分 类 号：R47[医药卫生—护理学]