摘要
目的调查北京某三甲医院老年社区获得性肺炎(CAP)住院患者的诊治现状,并与中国2016年版《成人社区获得性肺炎诊断和治疗指南》推荐的诊治方案进行对比,探讨诊治过程中存在的问题。方法选择2020年1月至12月于首都医科大学附属北京友谊医院住院的295例老年CAP患者为研究对象。根据CAP评分量表(CURB-65)与肺炎严重指数(PSI)分别对患者进行分组,将患者分为应门诊治疗组与应住院治疗组,比较2组患者一般资料、入院治疗场所、病原学及初始抗生素使用情况。采用SPSS 23.0统计软件进行数据分析。根据数据类型,分别采用t检验、秩和检验或χ^(2)检验进行组间比较。结果根据CURB-65评分符合住院标准(3~5分)的老年CAP患者34例,根据PSI评分符合住院标准(Ⅳ~Ⅴ级)的老年CAP患者147例。与应门诊治疗组相比,应住院治疗组老年CAP患者多为高龄且多来源于急诊,患者住院时间长,预后差。病原学:94.6%(279/295)的患者入院后进行病原学检测,其中痰涂片阳性率为79.9%(155/194);革兰阳性球菌占比居首,达29.7%(46/155)。痰培养阳性率为32.1%(70/218),真菌占比居首,达20.0%(14/70),支原体阳性率为28.4%(21/74)。初始抗生素应用:根据CURB-65评分量表分组,应门诊治疗组患者应用三代头孢21.8%(57/261)及喹诺酮类21.5%(56/261)抗生素的比例高;应住院治疗组患者应用碳青霉烯类35.3%(12/34)及碳青霉烯联合其他抗生素23.5%(8/34)的比例明显高于应门诊治疗组(P<0.05)。结论半数以上老年CAP患者入院评分低,病情偏轻,未达到指南推荐的住院标准,需进一步加强对指南的依从性。应用CURB-65量表评估老年CAP病情严重程度存在一定的局限性,PSI评分对老年CAP患者进行死亡风险评估价值更高。符合住院标准的老年CAP患者入院初始抗生素的使用种类基本符合指南的要求。
Objective To investigate the current diagnosis and treatment status of elderly patients with community acquired pneumonia(CAP)in an upper first-class hospital in Beijing,and compare the obtained data with Chinese 2016 CAP Diagnosis and Treatment Guidelines in order to explore the problems existing in the process of diagnosis and treatment.Methods A total of 295 elderly patients suffering from CAP admitted in our hospital from January to December 2020 were recruited in this study.According to their CURB-65(confusion,urea,respiratory rate,blood pressure,and age≥65 years)score for pneumonia severity assessment and pneumonia severity index(PSI),they were divided into outpatient and inpatient groups.The general information,admission site,pathogenic bacteria and initial antibiotic use were analyzed and compared between the two groups.SPSS statistics 23.0 was used to perform the statistical analysis.Student′s t test,Rank sum test or Chi-square test was employed for intergroup comparison based on different data types.Results For the 295 elderly CAP patients,there were 34 cases meeting the criteria for hospitalization according to the CURB-65 score(3-5 points),and 147 cases meeting the criteria based on the PSI score(gradeⅣ-Ⅴ).The patients from the inpatient group were mostly of advanced age and admitted from emergencies,and had longer length of hospital stay and worse prognosis when compared with those from the outpatient group.There were 94.6%(279/295)receiving pathogenic test after admission,and the results indicated the positive rate of sputum smear was 79.9%(155/194),with Gram-positive cocci taking the top[29.7%(46/155)],the positive rate of sputum culture was 32.1%(70/218),with Fungi accounting for 20.0%(14/70),and positive rate of mycoplasma was 28.4%(21/74).On the basis of CURB-65 score,the proportions of third-generation cephalosporin usage[21.8%(57/261)]and quinolone usage[21.5%(56/261)]were quite high in the outpatient treatment group.The proportions of carbapenems[35.3%(12/34)]and carbapenems combined with other antibiotics[23.5%(8/34)]were significantly higher in inpatient group than outpatient group(P<0.05).Conclusion More than half of the elderly patients with CAP have low admission score and mild conditions,and did not meet the criteria for hospitalization recommended by the guidelines.Therefore,we need to further strengthen compliance with the guidelines.The CURB-65 scale has some limitations in the assessment of CAP severity in the elderly,and PSI has a higher value in evaluation of mortality risk of these patients.For the CAP elderly patients who meet the criteria for hospitalization,the type of their initial antibiotic use basically meet the requirements of the guidelines.
作者
刘春艳
姜春燕
李虹伟
王丽娜
LIU Chun-Yan;JIANG Chun-Yan;LI Hong-Wei;WANG Li-Na(Department of Internal Medicine, Health Care Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China)
出处
《中华老年多器官疾病杂志》
2022年第1期15-19,共5页
Chinese Journal of Multiple Organ Diseases in the Elderly
基金
北京市医院管理局重点医学专业发展计划(ZYLX201838)
首都卫生发展科研专项项目(首发2020-2-1101)。
作者简介
通信作者:姜春燕,E-mail:jchy12368@sina.com。
