四所医院社区获得性肺炎初始治疗阶段经气管镜介入治疗效果及疾病负担比较  

Comparison of efficacy and disease burden of tracheoscopy intervention in the initial treatment stage of community-acquired pneumonia in four hospitals

作　　者：王鹏[1,5] 胡珍丽[2] 钱叶长 张国清 李星晶 白冲 WANG Peng;HU Zhenli;QIAN Yechang;ZHANG Guoqing;LI Xingjing;BAI Chong(Department of Respiratory Medicine,Baoshan Branch of Shanghai First People’s Hospital,Shanghai Jiao Tong University,Shanghai 200940,P.R.China;Department of Respiratory and Critical Care Medicine,The First Affiliated Hospital of the Naval Medical University,Changhai Hospital,Shanghai 200433,P.R.China;Department of Respiratory Medicine,Baoshan Integrated Traditional Chinese and Western Medicine Hospital,Shanghai 201900,P.R.China;Department of Respiratory and Critical Care Medicine,Shanghai First People’s Hospital,Shanghai Jiao Tong University,Shanghai 200080,P.R.China)

机构地区：[1]上海交通大学附属上海市第一人民医院宝山分院呼吸内科,上海200940 [2]海军军医大学附属第一医院长海医院呼吸与危重症医学科,上海200433 [3]上海市宝山区中西医结合医院呼吸内科,上海201900 [4]上海交通大学附属上海市第一人民医院呼吸与危重症医学科,上海200080 [5]上海复旦大学附属中山医院吴淞医院呼吸内科

出　　处：《中国呼吸与危重监护杂志》2020年第4期337-341,共5页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：卫生部卫生行业科研专项基金(编号201302017)。

摘　　要：目的探讨社区获得性肺炎(CAP)经气管镜介入治疗的疗效,并分析比较其经济负担。方法回顾性分析2017年7月1日至2018年8月31日四所医院(长海医院、上海市第一人民医院、上海市第一人民医院宝山分院、上海市宝山区中西医结合医院)呼吸科住院治疗的419例CAP患者临床资料。根据气管镜介入治疗时间段分为3组,在初始治疗期(取得影像学诊断72 h内)进行气管镜干预治疗的127例患者纳入早期干预组;在初始治疗后(取得影像学诊断72 h以后)进行气管镜干预治疗的158例患者纳入中期干预组;134例在治疗中未进行气管镜干预治疗的患者纳入未干预组。比较各组治疗总有效率、临床症状改善情况、影像学吸收情况、血清炎症指标水平、痰培养阳性率、换药率、换药后有效率、住院时间及住院费用。结果早期干预组治疗总有效率高于中期干预组和未干预组,差异有统计学意义(P<0.05);早期干预组体温恢复正常时间、浓痰及咳嗽消失时间、胸部X线片吸收时间均短于中期干预组和未干预组,差异有统计学意义(P<0.05);治疗7 d后,早期干预组外周血白细胞、血清降钙素原和超敏C反应蛋白水平低于中期干预组和未干预组,差异有统计学意义(P<0.05);早期干预组和中期干预组的痰培养阳性率、换药率均高于未干预组,差异有统计学意义(P<0.05);早期干预组住院天数短于中期干预组和未干预组,住院费用少于中期干预组和未干预组,差异有统计学意义(P<0.05)。结论初始治疗期气管镜介入治疗CAP患者不仅疗效显著提高,治疗费用也明显减少、住院时间缩短,值得临床推广。Objective To explore the efficacy of community-acquired pneumonia(CAP)by tracheoscopy intervention altimeter and analyze and compare its financial burden.Methods Retrospective analysis of 419 hospitalized patients with CAP was carried in respiratory medicine department of four hospitals from July 1,2017 to August 31,2018(Changhai Hospital,Shanghai First People’s Hospital,Baoshan Branch of Shanghai First People’s Hospital,and Baoshan Integrated Traditional Chinese and Western Medicine Hospital).According to the time of tracheoscopy intervention treatment,they were divided into 3 groups:127 patients treated with tracheoscopy intervention during the initial treatment period(within 72 h after obtaining imaging diagnosis)were included in an early intervention group,158 patients treated with tracheoscopy intervention 72 h after obtaining imaging diagnosis were included in a medium-term intervention group,and 134 patients treated without tracheoscopy intervention were included in a non-intervention group.The total efficiency of treatment,improvement of clinical symptoms,imaging absorption,serum inflammation index level,sputum culture positive rate,change rate,efficiency after drug change,hospital stay and hospitalization cost were compared among three groups.Results The total efficiency of treatment in the early intervention group was higher than that of the medium-term intervention group and the non-intervention group,with statistically significant difference(P<0.05),and the time of normality of body temperature,the time of disappearance of strong sputum and cough in the early intervention group,the absorption time of chest X-rays were shorter than that of the medium-term intervention group and the non-intervention group,and the difference was statistically significant(P<0.05);peripheral blood hemoglobin,serum calcitonin and hypersensitive C reactive protein levels were lower than those in the medium-term intervention group and the non-intervention group,with statistically significant differences(P<0.05),and the sp

关 键 词：社区获得性肺炎 初始治疗期 气管镜介入 疾病负担 

分 类 号：R563.1[医药卫生—呼吸系统]