贵阳地区儿童社区获得性肺炎病原学分析

2006年1月～2007年12月,我们对233例社区获得性肺炎(CAP)患儿的痰、血清标本分别进行了痰细菌培养及血清呼吸道病原学检测,以探讨CAP感染状况.     

不同吸痰深度密闭式吸痰法对呼吸机相关肺炎影响的研究

目的探讨密闭式吸痰法不同吸痰深度对呼吸机相关肺炎(VAP)的影响。方法选取河南省人民医院呼吸与危重症ICU 2016年12月-2018年6月需要行机械通气治疗的237例患者,按随机数字表法分为浅部吸痰组(A组,吸痰管插入的深度较气管插管短1 cm)、深部吸痰组(B组,吸痰管插入气管插管深部遇阻力后上提1 cm)和标准吸痰组(C组,吸痰管插入的深度较气管插管长2 cm),各组79例。对三组患者的基线资料、吸痰效果、VAP发生率及发生时间进行比较。结果三组患者机械通气5d、10d后VAP发生率有差异(P 0. 05); B组(12. 66%、17. 72%)和C组(8. 86%、15. 20%)明显低于A组(30. 38%、37. 97%; P0. 05),但B组和C组之间无明显差异(P 0. 05)。三组患者VAP的发生时间有差异(P 0. 05); B、C组VAP的发生时间较A组延长(P 0. 05)。B、C组的痰鸣音改善评分、SpO_2恢复时间及24 h吸痰次数与A组相比有差异(P 0. 05); A、C组的痰中带血、呛咳、心率改变的发生率较B组明显减少(P 0. 05)。结论标准吸痰深度密闭式吸痰法可安全有效的预防和延缓VAP的发生。     

针吸,血培养和血清学检查院外获得性肺炎病原学比较

针吸、血培养和血清学检查院外获得性肺炎病原学比较临沭县人民医院（２７６７００）王维玺为了获得肺炎患者准确的病原学诊断，我们采用针吸（经气管、经胸）方法采取其无咽部菌群污染的呼吸道标本分离病原菌，并与血培养、血清学检查院外获得性肺炎的病原学结果做对照，...     

规范化护理操作流程对婴幼儿社区获得性肺炎吸痰效果的影响

［摘要］　目的　探讨规范化护理操作流程在婴幼儿社区性获得性肺炎（CAP）吸痰中的应用效果。方法　把符合研究对象的124例婴幼儿肺炎,按规范化护理操作流程（用物和患儿准备、对家长进行疾病和检查知识认知及对家属心理干预、具体护理操作规程）经口腔、鼻腔和喉镜直视下吸痰获得痰液标本,从痰液合格标本例数、阳性标本例数、获得合格标本吸痰次数及负面影响（呼吸道黏膜影响、家属配合程度）评价规范化护理操作流程的意义。结果　痰液合格率为70.2%(87/124）;阳性标本：共检出135株细菌病原菌,其中革兰阴性(G^-)杆菌93株(68.9%),革兰阳性(G⁺)球菌42株(31.1%);一次取痰成功120例（96.8%）;负面影响：气道黏膜损伤出血3例（2.42%）,血氧饱和度降低（<90%）4例（3.23%）;家长配合程度：未出现0分现象,1分3例（2.42%）,2分121例（97.58%）。结论　遵照规范化的护理操作流程进行护理一次取痰成功率较高,对家属、患儿的负面影响较小,有助于婴幼儿CAP的临床诊疗。     

老年社区获得性肺炎病原学分析

目的研究老年社区获得性肺炎患者的病原体分布。方法收集2005年6月-2008年5月在我院住院的128例老年CAP患者,留取呼吸道分泌物进行细菌培养,分离鉴定细菌并进行药物敏感性试验,同时检测患者急性期和恢复期肺炎支原体、肺炎衣原体、嗜肺军团菌血清抗体。结果 128例CAP患者60例（46.9%）病原学检查阳性,病原菌45株,其中主要为流感嗜血杆菌14株,肺炎克雷伯杆菌12株,肺炎链球菌10株。非典型病原阳性18例,主要为肺炎支原体13例,肺炎衣原体4例,3例为混合感染。流感嗜血杆菌对氨苄西林耐药率为14.3%;肺炎链球菌对青霉素不敏感率为30%,对阿齐霉素耐药率为60%;肺炎克雷伯菌产酶率16.7%,对含β-内酰胺酶抑制剂的复方抗生素制剂和亚胺培南敏感。结论老年患者肺炎以革兰阴性菌为优势菌株,对喹诺酮类和第3代头孢菌素具有不同程度的耐药性,对革兰阴性菌选用含有酶抑制剂的复方抗生素制剂或亚胺培南,非典型病原体的感染也占重要地位。     

密闭式吸痰预防迟发型呼吸机相关性肺炎

目的观察密闭式吸痰对迟发型呼吸机相关性肺炎（VAP）发生率的影响。方法根据吸痰方式的不同将59例机械通气患者随机分为密闭组和开放组,分别使用密闭式吸痰和开放式吸痰治疗,比较两组VAP的发生率和28d死亡率。结果密闭组迟发型VAP的发生率低于开放组（P〈0．05）,两组总VAP发生率、早发型VAP发生率和28d死亡率无差异。结论密闭式吸痰可以降低迟发型VAP的发生率。     

盐酸氨溴索诱导痰与传统诱导痰法在老年社区获得性肺炎临床应用的比较

目的比较盐酸氨溴索导痰与传统法导痰在老年社区获得性肺炎中的临床应用。方法将120例60岁以上老年社区获得性肺炎患者入院时随机分成两组。A组用3％盐水2ml＋盐酸氨溴索15mg,B组用3％高渗盐水4ml,分别进行压缩雾化导痰,两组患者痰液送检并进行痰培养。结果A组不良反应发生率为3．3％,B组为30．0％;A组排痰成功率为98．3％,合格率88．3％,B组排痰成功率为75．0％,合格率71．7％。以上差异均有统计学意义（P〈0．05）。A,B两组导痰的痰量分别为（9．5±2．0）ml和（7．5±2．3）ml;细胞数分别为（9．5±1．3）×10^9L和（10．2±1．3）×10^9L;肿瘤坏死因子α（TNF-α）水平分别为（74±9）ng／L和（61＋8）ng／L;白介素-8（IL-8）水平分别为（96±8）ng／L和（84±56）ng／L;痰培养阳性率分别为70．0％和50．0％。A,B两组在痰量、细胞数、TNF-α和IL-8、痰培养阳性率方面的差异均有统计学意义（P〈0．05）。结论在老年社区获得性肺炎患者中盐酸氨溴索导痰较传统导痰法更加安全有效。     

吸痰的护理

吸痰是保持呼吸道通畅的重要措施，能够及时地解除呼吸道痰液堵塞，保证有效通气，但也可带来诸多副作用，如损伤气道、刺激气道产生分泌物等。正确的吸痰方法则可减少气道黏膜的损伤。     

吸痰方法的改进及护理

清理呼吸道无效患者不能依靠有效的自主咳嗽咳痰维持气道的通畅，只有借助吸痰才能解决痰液潴留问题。气管切开患者大都病情危重，并存在不同程度的意识障碍，保护性咳嗽反射减弱，甚至消失，自行排痰困难．应用安全有效的吸痰方法，避免了因吸痰操作不当引起的各种并发症，从而提高了患者的救治率和护理质量。[第一段]     

社区获得性肺炎病原学诊断技术与临床合理应用北大核心CSCD

社区获得性肺炎fcommunity—acquiredpneumonia,CAP）是发病率较高的感染性疾病,虽然病死率不高,但总体病死人数众多。欧洲及北美成人CAP发病率为（5—11）／1000人／年,其发病率和病死率随年龄增长而增加,     

Epidemiology and etiology of community-acquired pneumonia

The seriousness of community-acquired pneumonia (CAP), despite being a reasonably common and potentially lethal disease, often is under estimated by physicians and patients alike. CAP results in more than 10 million visits to physicians, 64 million days of restricted activity, and 600,000 hospitalizations. This article discusses the epidemiology and bacterial causes of CAP in immunocompetent adults and the severe acute respiratory syndrome coronavirus.     

社区获得性呼吸道感染主要致病菌及其耐药性变化

肺炎链球菌(SP)和肺炎支原体(MP)是我国社区获得性肺炎(CAP)的最常见病原体,另外,细菌合并非典型病原体的混合感染亦不可忽视。SP对大环内酯类抗菌药物的耐药率迅速增加,并且其对青霉素的耐药性仍呈上升趋势。MP对大环内酯类抗菌药物的耐药率也在增加。而喹诺酮类药物对SP及非典型病原体仍具有较强抗菌活性。金黄色葡萄球菌是CAP的少见病原体,但是随着社区获得性耐甲氧西林金黄色葡萄球菌在世界范围内的增加,已引起了临床的重视。     

社区获得性肺炎的诊治进展

社区获得性肺炎的诊断和治疗方法近年来在不断完善,但是社区获得性肺炎的正确诊断及合理化治疗仍然是临床医师需要面临的问题.本文对社区获得性肺炎的诊治进展情况进行介绍.     

Microbiologic diagnosis of community-acquired pneumonia in adults

Microbiological analysis allows us to identify the etiology of pneumonia and its in vitro susceptibility pattern. Antibiotic treatment directed against a known pathogen enables us to narrow antibacterial spectrum of action, and to reduce costs, drug adverse effects risk and antibiotic resistance. However it is unnecessary to perform extended microbiological studies in all patients with community acquired pneumonia (CAP). Etiological studies must be based in pneumonia severity, epidemiological risk factors and clinical response to empirical treatment. Routine microbiological analysis for ambulatory patients is not recommended. In patients with persistent cough and worsening in their general conditions, a sputum sample must be obtained to perform an acid-fast smear and Mycobacterium culture. The risk of complications and death of patients hospitalized with CAP justifies basic microbiological exploration (sputum Gram staining and culture, blood cultures, pleural fluid culture) intending to obtain a more accurate etiology of pulmonary infection and to guide specific antibiotic treatment. Paired serum samples obtained to document atypical pathogen infections (Mycoplasma pneumoniae, Chlamydia pneumoniae) and urine sample to detect Legionella pneumophila antigenuria are recommended in all CAP severely ill patients that are admitted to ICU, in those not responding to betalactamic drug treatment and in selected patients with specific epidemiological risks. A microbiological study would be useful in management of patients with severe CAP pneumonia outbreaks with clinical-epidemiological particular characteristics, and in-patients with empirical antimicrobial treatment failure.     

Impact of alcohol abuse in the etiology and severity of community-acquired pneumonia

BACKGROUND AND STUDY OBJECTIVES: Alcohol consumption is known to affect both systemic and pulmonary immunity, predisposing the patient to pulmonary infections. The aim of this study was to compare the etiology of disease, the antibiotic resistance of Streptococcus pneumoniae, the severity of disease, and the outcome of patients with alcohol abuse to those of nonalcoholic (NA) patients who have been hospitalized for community-acquired pneumonia (CAP). METHODS: From 1997 to 2001, clinical, microbiological, radiographic, and laboratory data, and follow-up variables of all consecutive patients who had been hospitalized with CAP were recorded. Patients were classified as alcoholic (A) [n = 128] or ex-alcoholic (EA) patients (n = 54) and were compared to NA patients (n = 1,165). RESULTS: S pneumoniae was found significantly more frequently in all patients with alcohol misuse. As regards the rates of antibiotic resistance, invasive pneumococcal disease, and other microorganisms, no differences were found. The severity criteria for CAP according to the American Thoracic Society were more frequent in A patients, but mortality did not differ significantly. Multivariate analysis showed an independent association between pneumococcal CAP and alcoholism (A patients: odds ratio [OR], 1.6; p = 0.033; EA patients: OR, 2.1; p = 0.016). CONCLUSIONS: We found an independent association between pneumococcal infection and alcoholism. Current alcohol abuse was associated with severe CAP. No significant differences were found in mortality, antibiotic resistance of S pneumoniae, and other etiologies.     

Clinical and radiological diagnosis of community-acquired pneumonia in adults

Community acquired pneumonia in adults is an acute disease characterized by worsening in general conditions, fever, chills, cough, mucopurulent sputum and dyspnea; associated with tachycardia, tachypnea, fever and focal signs in pulmonary examination. The probability of pneumonia in a patient with acute respiratory symptoms depends on the disease prevalence in the environment where it is acquired and on clinical features. It is estimated that pneumonia prevalence is 3-5% in patients with respiratory disease seen in outpatient facilities. Clinical diagnosis of pneumonia without radiological confirmation lacks specificity because clinical presentation (history and physical examination) does not allow to differentiate pneumonia from other acute respiratory diseases (upper respiratory infections, bronchitis, influenza). Diagnosis must be based in clinical-radiological findings: clinical history and physical examination suggest the presence of pulmonary infection but accurate diagnosis is established when chest X ray confirms the existence of pulmonary infiltrates. Clinical findings and chest X ray do not permit to predict with certainty the etiology of pulmonary infection. Radiology is useful to confirm clinical suspicion, it establishes pneumonia location, its extension and severity; furthermore, it allows differentiation between pneumonia and other diseases, to detect possible complications, and may be useful in follow up of high risk patients. The resolution of radiological infiltrates often ensues several weeks or months after clinical recovery, especially in the elderly and in multilobar pneumonia cared for in intensive care units.     

社区获得性肺炎诊疗新进展

近年来,社区获得性肺炎流行调查显示其患病率及病死率逐渐增高,重症患者增多。而在临床诊疗上,存在病原学诊断不清、对血清学检测意义认识不足、严重程度评估欠准确、抗生素不合理应用等现象。本文参阅了大量近年来国内外发表的有关社区获得性肺炎的最新文献,在血清学、病原学、抗生素合理使用、是否应用激素、辅助治疗及诊治前沿新进展等方面进行综述。     

2001年至2003年上海地区社区获得性肺炎的病原学调查

目的了解上海地区社区获得性肺炎病原的分布和耐药情况，为经验治疗提供依据。方法对2岁以上的389例社区获得性肺炎患者留取痰标本进行细菌培养和药物敏感试验，并采用DNA检测、血清学方法和尿抗原测定检测非典型病原。结果155例患者病原检测阳性，其中28例为混合感染。病原菌共123株，主要为嗜血杆菌属、肺炎链球菌和克雷伯菌属。非典型病原阳性61例，主要为肺炎支原体。嗜血杆菌属细菌产酶率为7．8％，对阿奇霉素、头孢呋辛等所测抗菌药物均呈敏感。肺炎链球菌中多为青霉素敏感株，对头孢曲松、左氧氟沙星和万古霉素则全部呈现敏感。结论嗜血杆菌属仍是社区获得性肺炎的主要病原之一，非典型病原亦占重要地位。青霉素和阿莫西林仍可作经验用药，在青霉素不敏感肺炎链球菌流行地区可增大剂量，或改用第二、三代头孢菌素。新大环内酯类和新氟喹诺酮类亦可作为经验用药之一。