郭涛,芮庆林,仲跻巍,段宝奇,黄洋,李津金,陈剑.急诊重症院内获得性肺炎的诊治体会[J].内科急危重症杂志,2016,22(6):
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| DOI： |
| 中文关键词: 重症肺炎 院内获得性肺炎 抗生素耐药 预后 |
| 英文关键词:Severe pneumonia Hospital-acquired pneumonia Antibiotic resistance Prognosis |
| 基金项目:江苏省中医院院级课题(基金号：Y12026)邮编：210029,江苏省南京市,第一作者单位南京中医药大学附属江苏省中医院EICU(郭涛 芮庆林 仲跻巍 段宝奇 黄洋 李津金 陈剑)第一作者信息郭涛,男,主治医师,硕士研究生,(1977年10月-) ﹡通讯作者陈剑,主治医师,硕士研究生,(1981年12月-),邮箱：saharaicu@126.com |
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| 中文摘要: |
| 目的：观察急诊重症肺炎患者的细菌耐药情况和预后。 方法：对50例收住急诊及EICU的重症肺炎患者进行前瞻性观察研究,分析患者一般情况、初始痰培养结果和药敏试验、机械通气时间及病死率。 结果：初始细菌培养阳性菌株53株,其中革兰氏阴性菌39株 (73.6%),以铜绿假单胞菌(28.3%)、鲍曼不动杆菌(18.9%)、肺炎克雷伯杆菌(11.3%)为多见；革兰氏阳性菌14株(26.4%),均为耐甲氧西林金黄色葡萄球菌(MRSA)。细菌耐药情况严重。所有患者30d粗病死率为16%(8/50)。在48例初始细菌培养阳性患者中,恰当初始抗生素应用率为63.8%(27/43)；治疗恰当与不恰当组的机械通气时间分别为8.9±5.2d和15.4±10.1d,差异有统计学意义(P<0.05)；2组30d粗病死率分别为11.1%和25.0%,差异有统计学意义(P<0.05)。结论：急诊重症院内获得性肺炎的致病菌耐药率高,恰当初始抗生素治疗可以降低机械通气时间。应加强细菌耐药性监测及抗生素合理使用。 |
| 英文摘要: |
| Objective: To observe the drug resistance to antimicrobics in treating patients with severe hospital-acquired pneumonia(HAP) in emergency and its prognosis. Methods: Fifty cases with severe HAP were included in the prospective study. Initial sputum bacterial culture, bacterial sensitivity,days of mechanical ventilation and mortality were analyzed． Results: Totally 53 strains of pathogens were isolated by initial bacterial culture． The G- bacteria was 39 ( 73.6%) among which pseudomonas aeruginosa(28.3%),Acinetobacter baumannii (18.9%) and Klebsiella pneumoniae(11.3%) were commonly seen. G bacteria was 26.4% in which all were methicillin-resistant staphylococcus aureus (MRSA). The condition of drug resistance was serious．The overall crude 30-day mortality rate was 16% (8/50)．Of 43 cases whose initial bacterial culturing were positive, 27 patients received appropriate initial antimicrobial therapy( AIAT,63.8%)．Days of mechanical ventilation in AIAT group and non-AIAP group were 8.9 ± 5.2 and 15.4 ± 10.1d respectively (P<0.05)．There was significant difference in the crude 30-day mortality between the two groups( 11.1% vs 25.0%,P<0.05)．Conclusions: Antimicrobial resistance was serious in severe HAP in emergency． AIAT can reduce days of mechanical ventilation． It is suggested that an urgent surveillance of bacterial resistance and rational use of antimicrobial agents should be strengthened． |
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