天津地区社区获得性肺炎临床稳定和经验治疗后评价的研究

发布时间：2018-10-31 10:39

【摘要】：目的探讨社区获得性肺炎(CAP)入院后48小时和72小时评估达到临床稳定的患者比例,研究天津地区影响CAP患者达到临床稳定的相关因素；分析影响CAP患者入院后抗生素调整及预后的相关因素；调查社区获得性肺炎遵循指南选择抗生素使用情况。方法收集天津地区10所医院在2010年3月至2011年6月期间的收治的所有CAP病例,记录CAP患者达到临床稳定性的时间,并分析患者的年龄、性别、基础疾病、CURB评分、入院前、后使用抗生素与临床稳定的关系；分析CAP患者年龄、性别、基础疾病、CURB评分、入院前、后使用抗生素与患者入院后抗生素方案调整及预后的关系。结果 1)在701例CAP患者中,有394例患者在入院后72小时达到临床稳定,占总患者比例的56.2%,其中有183例患者在入院后48小时达到临床稳定,占总患者比例的26.2%,影响48小时达到临床稳定的相关因素有：年龄、合并基础疾病(合并COPD、冠心病)、CURB评分。 2)CAP患者入院后抗菌药物使用率为100.0%,CAP患者入院后初始治疗抗生素的选择比例依次为：单用β内酰胺类(23.4%)、β内酰胺类+大环内酯类(17.9%),单用莫西沙星(13.6%)、单用左氧氟沙星(12.4%),单用大环内酯类(8.9%)、β内酰胺类+喹诺酮类(7.8%)、β内酰胺类+氨基糖苷类(6.4%)、其它(9.2%)。入院后抗生素选择使用莫西沙星的CAP患者72小时后抗生素方案调整率低于β-内酰胺类+大环内酯类,差别具有统计学意义。 3)CAP患者预后仅显示与年龄有关,年龄越高,治疗效果越差；与CAP患者的性别、合并基础疾病与否、CURB评分及入院后选择使用不同种类的抗生素无关,差别不具有统计学意义。 4)在701例CAP患者中,427例CAP患者符合入院标准,占所有入院患者的67.4%,入院后遵循指南选择抗生素的CAP患者有309例,所占比例为43.9%。结论 1)研究显示,超过一半CAP患者在72小时内达到临床稳定,影响临床稳定的相关因素有：年龄、合并基础疾病(合并COPD、冠心病)、CURB评分。 2)莫西沙星的72小时后抗生素方案调整率低于β-内酰胺类+大环内酯类,CAP患者预后仅显示与年龄有关,年龄越高,治疗效果越差。 3)部分CAP患者入院标准及入院后抗生素选择不符合指南要求,有待进一步规范。
[Abstract]:Objective to investigate the proportion of patients with community-acquired pneumonia (CAP) who achieved clinical stability 48 hours and 72 hours after admission, and to study the related factors that affect the clinical stability of CAP patients in Tianjin area. To analyze the related factors of antibiotic adjustment and prognosis after admission in CAP patients and investigate the use of antibiotics according to the guidelines of community acquired pneumonia. Methods all cases of CAP were collected from 10 hospitals in Tianjin from March 2010 to June 2011. The time of clinical stability of CAP patients was recorded, and the age, sex, basic disease and CURB score were analyzed. The relationship between antibiotic use and clinical stability before and after admission; To analyze the relationship between age, sex, basic disease, CURB score, antibiotic use before and after admission and the adjustment of antibiotic regimen and prognosis in patients with CAP. Results 1) among 701 patients with CAP, 394 patients reached clinical stability at 72 hours after admission, accounting for 56.2 percent of the total number of patients, and 183 patients reached clinical stability 48 hours after admission. The related factors affecting clinical stability in 48 hours were age and basic disease (), CURB score of COPD, coronary heart disease). 2) the antibiotic utilization rate of CAP patients was 100.0%. The selection rate of antibiotics in the initial treatment was: 尾 lactam alone (23.4%), 尾 lactam macrolides (17.9%), 尾 lactam group (17.9%), 尾 lactam group (23.4%), 尾 lactam group (17.9%), and 尾 lactam group (17.9%). Moxifloxacin alone (13.6%), levofloxacin (12.4%), macrolides (8.9%), 尾 lactams (7.8%), 尾 lactams (6.4%), 尾 lactams (6.4%), Others (9.2%). The adjustment rate of antibiotic regimen in CAP patients who were treated with moxifloxacin 72 hours after admission was lower than that of 尾-lactam macrolides, and the difference was statistically significant. 3) the prognosis of CAP patients was only related to age. The higher the age, the worse the therapeutic effect. There was no significant difference in the sex of CAP patients, the combination of underlying diseases or not, the CURB score and the choice of different kinds of antibiotics after admission. 4) of the 701 patients with CAP, 427 patients with CAP met the admission criteria, accounting for 67.4 percent of all the hospitalized patients. 309 patients with CAP followed the guidelines to select antibiotics after admission, accounting for 43.9 percent. Conclusion 1) the study showed that more than half of CAP patients reached clinical stability within 72 hours. The related factors influencing clinical stability were age and basic disease (), CURB score of COPD, coronary heart disease). 2) after 72 hours of moxifloxacin, the adjustment rate of antibiotic regimen was lower than that of 尾 -lactam macrolides. The prognosis of patients with CAP was only related to age. The higher the age, the worse the therapeutic effect. 3) the admission criteria and antibiotic selection of some CAP patients do not meet the requirements of the guidelines and need to be further standardized.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R563.1

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