重症SARS患者急性期后院内获得性肺炎

目的 评价重症SARS患者急性期后出现院内获得性肺炎(HAP)的原因及其处理策略。方法 回顾性分析9例已经接受治疗约1月的重症SARS患者的基础疾病、并发症、治疗经过和急性期后发生HAP的诊治状况。结果 9例重症SARS急性期后患者，7例发生HAP，其中的3例确诊为真菌感染；经抗感染和其他综合治疗后．8例存活、1例死亡，总的存活率为88．9％，HAP的存活率为85．7％。结论 重症SARS急性期缓解后易发生HAP，真菌感染的发生率较高；机体免疫力受损、长期大剂量使用激素和广谱抗生素、高血糖、合并有慢性基础疾病是SARS急性期后出现HAP的主要原因；消除导致患者发生继发感染的可能因素、积极处理并发症、合理使用抗生素、有效地营养支持和免疫调节治疗，可使重症SARS急性期后HAP患者达到较高的救治成功率。

Hospital Acquired Pneumonia Occurring after Acute Stage of the Serious SARS and Its Treating Strategies

OBJECTIVE To evaluate the causes and treating strategies of hospital acquired pneumonia (HAP) occurring after the acute stage of the serious SARS patients. METHODS To analyse retrospectively the underlying conditions, complications, treating process of the serious SARS and diagnosis, treatment of HAP occurring in the serious SARS patients had been treated about a month. RESULTS Seven had HAP in 9 cases of the serious SARS patients occurring after the acute stage, 3 of them were infected by fungi; 8 survived and 1 died after anti-infective and combined therapy. Total survival rate was 88.9% and the survival rate of HAP patients was 85.7%. CONCLUSIONS The serious SARS patients resulted easily in HAP after remission at the acute stage,incidence of fungal infection was rather high. The major causes of HAP occurring after the acute stage of SARS included defected immunity, long use of high doses of glucocorticoids and broad-spectrum antibiotics, hyperglycemia, complicated by chronic underlying condition; the ways to improve the survival rate of HAP occurring after the acute stage of SARS were to preclude the possible factors which resulting in secondary infection, to treat actively the underlying diseases and complications, to use reasonable antibiotics, to apply effective nutrition support and immunoregulating therapy.