我国医院内肺炎流行病学现状：20世纪90年代发表论文的荟萃分析

目的：研究我院医院内肺炎（NP）的发病率，病死率，常见临床表现和病原谱，为今后制订NP的控制规划提供依据，方法：通过广泛的文献检索和搜集，采用近年来国外已频繁应用的统计新概念Meta(荟萃）分析，对我国20世纪90年代发表的专门研究院内肺炎的临床流行病学调查结果进行汇总，归纳和统计分析。结果：共检索到文献344篇，有88篇进入Meta分析，总计报告NP病例8705例，其中32篇论文可用于NP发病率的统计，所监测的178 851队列 住院患者中，发生NP 4166例，NP总体发病率为2．33％，不同人群NP发病率差异很大，老年，ICU和机械通气患者NP发病率分别为普通住院患者的5．39，12．78，43．27倍；51篇研究提供有关NP预后即死亡的数据，监测的4468例NP中死亡1076例，总体病死率为24．08％，63篇提供NP病原学检查结果，大多数为经咯痰细菌培养获得检出的6026株病原菌中，革兰阴性杆菌4226株，占70．1％，革兰阳性球菌1241株，占20．6％，结论：我国NL的平均发病率为2．33％，高于全国医院感染监测网1．0－1．5％的发病率，病死率24．08％，病原体仍以革兰阴性杆菌为主。

Epidemiology of Nosocomial Pneumonia in China:Meta-analysis for Literature Published in 1990s

OBJECTIVE To understand the morbidity,mortality,clinicalmanifestation and pathogen spectrum of nosocomial pneumonia(NP) in China via systematically reviewing available articles published in 1990s.METHODS Data sources:all articles from 1990 to 1998 relevant to NP in main land of China were identified through“CBMdisc” and “Medline” search and article bibliographies.Study selection:344 articles were identified,88 articles were selected for meta-analysis based on inclusion and criteria.Data extraction:occurrence rates for morbidity and mortality,clinical manifestation and pathogens were extracted.RESULTS A total of 8 705 NP cases were reported in 88 articles.Data could be extracted for morbidity analysis in 32 articles;4 166 NP were identified among 178 851 hospitalized patients.The general incidence of NP is 2.33%.The incidence of NP in elderly,ICU,mechanical ventilation patients are 5.39%,12.78%,43.27%,respectively.Data could be extracted for mortality analysis in 51 articles;1 076 deaths were observed in 4 468 NP.The general fatal rate of NP is 24.08%.Pathogens of 6 026 strains were identified in 63 articles;4 226(70.1%) strains were gram-negative rods and 1 241(20.6%) were gram-positive cocci.CONCLUSIONS Mortality of NP in the meta-analysis is much higher than the data reported routinely in National Nosocomial Infection Surveillance Net.Elderly,ICU and mechanical ventilation are important risk factors of NP in China.