中国社区获得性肺炎诊断和治疗指南的评价

目的:评价中国社区获得性肺炎(community-acquired pneumonia,CAP)诊断和治疗指南中病情的评估标准.方法:以2002年7月至2004年6月就诊于我院的473例CAP患者为研究对象,通过前瞻性研究,应用SPSS10.0统计分析软件,分析患者的随访结果,评价指南中建议住院的各项危险因素对患者预后的影响.结果:(1)按我国CAP病情评估标准,重症肺炎病死率为28.9%,符合住院标准患者为1.9%,不符合住院标准患者为0;(2)脾切除术后状态、胸片出现空洞等因素没有出现或出现几率极低;(3)年龄＞65岁、糖尿病、慢性肾功能不全等13项危险因素在存活患者与非存活患者间差异有统计学意义,其中7项是影响预后的独立的危险因素(P＜0.05);另外,统计结果还显示合并肿瘤也是影响预后的危险因素.结论:我国CAP指南的病情评估标准能准确判断患者的不同风险;指南需要在循证医学指导下不断完善并推广实施.

Clinical evaluation of Chinese Guidelines for Community-Acquired Pneumonia

Objective: To evaluate the criteria of severity assessment of the Chinese Community-Acquired Pneumonia (CAP) Guidelines, and provide the evidence for carrying out the Guidelines completely. Methods: The medical records of 473 patients with CAP in our hospital from July 1, 2002 to June 30, 2004 were prospectively collected and analyzed with SPSS 10.0. Chi-square test and multinomial logistic regression to analyze the influence of risk factors listed in the Guidelines on the outcome of the patients in this cohort. Results: (1) The mortality in severe pneumonia group was 28.9%; hospitalized group, in qualified, and 0% in disqualified hospitalized groups; (2) The frequencies of some factors were few in the study, such as previous splenectomy, presence of cavity, ect; (3)There were 13 factors found to be significantly different between survivors and nonsurvivors, such as age>65yrs, diabetes mellitus, chronic renal failure, etc; of which 7 were independent risk factors associated with death (P< 0.05). Conclusion: (1) The severity assessment criteria of the Chinese CAP Guidelines can differentiate patients with different risks; (2) The Guidelines should be continuously and implemented under evidence-based guidance updated.