初始抗生素合理应用对重症肺炎患者预后的影响-东南大学学报医学版

初始抗生素合理应用对重症肺炎患者预后的影响

单位：马鞍山市人民医院急诊科, 安徽马鞍山 243000

分类号：R563.1;R969.3

出版年·卷·期（页码）：2014·33·第一期（63-66）

摘要：

目的：探讨初始抗生素的合理应用对重症肺炎的治疗效果和对预后的影响。方法：对53例重症肺炎患者的临床资料进行回顾性研究，分析患者初始抗生素应用情况、初始痰培养和药敏试验结果、机械通气和住ICU时间、总费用和病死率。结果：45例初始培养阳性患者中，初始抗生素合理使用率62.2%（28/45）；初始抗生素合理使用组和不合理组患者抗生素使用时间[（10.7±3.6） d和（17.5±5.1） d]、机械通气时间[（9.1±4.9） d和（14.9±6.7） d]、住ICU时间[（15.4±5.2） d和（20.6±5.9） d]和总费用[（57 191.5±370.2）元和（82 726.6±320.3）元]比较，差异均有统计学意义（P<0.05）；两组患者病死率（10.7%和23.5%）的差异无统计学意义（P >0.05）。结论：加强初始抗生素的合理应用以及对细菌耐药的监测，可缩短重症肺炎患者病程、改善预后，对减轻重症肺炎患者的医疗费用有一定的意义。

Objective: To explore the effects and prognosis of appropriate initial antimicrobial therapy in patients with severe pneumonia. Methods: A random sample of 53 cases with severe pneumonia were retrospectively studied in intensive care unit(ICU),including 14 cases with community-acquired pneumonia(CAP) and 39 cases with hospital-acquired pneumonia(HAP).Initial antimicrobial therapy, initial sputum culture,bacterial sensitivity,days of mechanical ventilation,length of stay, hospitalization costs and mortality were analyzed. Results: Of 45 cases whose initial sputum culture were positive,28 patients received appropriate initial antimicrobial therapy (AIAT,62.2%).Days of antibiotic therapy [(10.7±3.6)d vs (17.5±5.1)d]and mechanical ventilation[(9.1±4.9)d vs(14.9± 6.7)d],length of stay [(15.4±5.2)d vs (20.6±5.9)d] and hospitalization costs[(57 191.5±370.2)yuan vs (82 726.6±320.3) yuan] in AIAT group and IIAP (inappropriate initial antimicrobial therapy) group were significant different(P<0.05),although mortality(10.7% vs 23.5%) between two groups was not statistically significant (P>0.05).Conclusion: It is suggested that rationa1 initial antimicrobial therapy and a forceful surveillance of bacterial resistance can reduce length of stay and hospitalization costs, and ameliorate prognosis.

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