摘要
目的比较三级甲等医院和基层医院治疗社区获得性肺炎(CAP)的效果及费用,探讨其差别的原因。方法回顾性分析320例CAP患者,180例来自广东省人民医院(三级甲等医院)急诊和门诊的患者作为Ⅰ组;140例来自基层医院的CAP患者作为Ⅱ组,其中95例来自广东省交通医院,45例来自广东省人民医院南海平洲分院(目前相当于基层医院)。按治疗方法不同分为"急诊-留观-院外序贯治疗"(A方案)和"急诊-住院"模式(B方案)。比较Ⅰ组和Ⅱ组的全静脉抗生素使用时间,留院时间,5d内缓解率,治疗失败率,不良反应发生率,死亡率,平均治疗费用,以及采用治疗方案的不同。结果Ⅰ组5d内缓解率、治疗失败率及死亡率与Ⅱ组比较无明显差异(P均>0.05),但全静脉抗生素使用时间、留院时间、不良反应发生率及平均治疗费用短于或低于Ⅱ组(P均<0.05)。Ⅰ组较多采用A方案治疗(45%);Ⅱ组多采用B方案治疗(85%),仅少数采用A方案治疗(15%)。结论三级甲等医院比基层医院能更趋向于采用非住院方式治疗CAP,在降低费用的同时不影响疗效,且不良反应减少,应在基层医院推广采用"急诊-留观-院外序贯治疗"模式治疗CAP。
Objective To compare the efficacy and expenditure of community acquired pneumonia （CAP） patients by different therapeutic procedure between tertiary hospitals and primary hospitals. Methods 320 CAP patients were selected from two groups（group Ⅰand groupⅡ ） according to hospital levels, 180 cases from the Guangdong Provincial People＇s Hospital, 140 cases from the primary hespitals（95 cases from Guangdong Provincial Transportation Hospital and 45 cases from Nan-hal Community Branch of Guangdong Provincial People＇s Hospital）. All patients were managed with either therapeutic strategy A （initial antibiotic dose in emergency room - stay in observation room - switch to oral antibiotics） or therapeutic strategy B（ emergency room without initial antibiotic-admission）. The therapeutic efficacy of strategy A and B in the two groups was compared. Other parameters including intravenous antibiotics length,hospital days, the resolution rate in 5 days, treatment failure rate, adverse events rate, mortality and treatment cost were collected and compared. Results There were no significant differences in resolution rate in 5 days,treatment failure rate and mortality between the two groups （ all P 〉 0.05 ）. However, there were significant differences in length of intravenous antibiotics course, length of hospital stay, adverse events rate and treatment cost（ all P 〈 0.05 ）. There were more patients managed with therapeutic strategy A in group Ⅰ than in the group Ⅱ （45% vs 15%,P 〈 0.05） .Conclusions Tertiary hospitals manage CAP patients mere often in ambulatory setting resulting in satisfactory efficacy, lower medical cost, fewer adverse events, which should be extended to primary hospitals.
出处
《中国呼吸与危重监护杂志》
CAS
2007年第5期352-355,共4页
Chinese Journal of Respiratory and Critical Care Medicine
基金
广东省科技计划项目(编号:2004B33701019)
关键词
社区获得性肺炎
治疗模式
费用
Community acquired pneumonia
Management method
Treatment cost
作者简介
通讯作者：张红璇，E-mail：sandyzhx@hotmail．com
