发热门诊流行性感冒样患者228例抗生素应用情况分析

目的 分析发热门诊流行性感冒(流感)样病例的临床表现、抗生素应用情况,增强合理使用抗生素的意识.方法 以发热门诊228例流感样病例为研究对象,采用回顾性病例对照研究,按照是否应用抗生素分为两组,比较一般情况、临床表现、实验室检查结果及预后情况等.计量资料采用独立样本t检验,计数资料采用χ2检验.结果 228例发热门诊流感样病例的抗生素使用率为41.7%,两组患者性别、年龄、就诊时发病天数及最高体温比较,差异均无统计学意义(均P＞0.05).使用抗生素组与未用抗生素组患者咳嗽发生率分别为67.4%和44.4%(χ2=11.807,P=0.001)、咽痛发生率为55.8%和42.1%(χ2=4.159,P=0.041)、全身酸痛发生率为46.3%和31.6%(χ2=5.123,P=0.024).使用抗生素组患者血WBC(6.2±2.2)×109/L,高于未用抗生素组的(5.4±1.8)×109/L(t=2.673,P=0.008),使用抗生素组中性粒细胞为0.715±0.095,高于未用抗生素组的0.661±0.088(t=4.336,P＜0.01).40例流感快速检测阳性者中抗生素使用率为20.0%,低于检测阴性组的48.9%(χ2=10.594,P=0.001).是否使用抗生素患者的治疗疗程、诊后体温恢复正常时间、就诊前后总发热病程、痊愈时间比较,差异均无统计学意义(均P＞0.05).结论 抗生素使用与否对流感样病例的预后无明显影响.应根据发生流感并发症的高、低危人群及流感快速检测结果,有选择地使用抗生素.

Analysis of antibiotic treatment in 228 patients with influenza-like illness in fever clinic

Objective To investigate clinical manifestations and antibiotic treatment of patients with influenza-like illness in fever clinic,and strengthen reasonable use of antibiotics.Methods A total of 228 patients with influenza-like illness in fever clinic were analyzed retrospectively using case control study.The subjects were divided into 2 groups according to using antibiotics or not.The general conditions,clinical character,laboratory results and prognosis were compared.The comparison of quantitative data was done using independent t test.The qualitative data were compared using chi-square test.Results The utilization rate of antibiotics was 41.7% in 228 patients with influenza-like illness in fever clinic.The gender,age,days from onset to visiting doctors and the highest body temperature of patients between 2 groups were not significantly different(all P＞0.05).The incidence rates of cough,sore throat and muscular stiffness in using antibiotics group were all higher than those in not using antibiotics group[67.4% vs.44.4%(χ2 =11.807,P=0.001),55.8% vs.42.1%(χ2=4.159,P=0.041),46.3% vs.31.6%(χ2 =5.123,P=0.024)].The white blood cell count in the former group was(6.2±2.2)×109/L,which was higher than that in the latter group [(5.4±1.8)×109/L](t = 2.673,P = 0.008).The neutrophile granulocyte count in the former group was 0.715±0.095,which was higher than that in the latter group(0.661±b0.088)(t=4.336,P＜0.01).The antibiotic utilization rate in patients whose diagnosis of influenza were positive was 20.0% which was lower than that in those whose rapid diagnoses were negative(48.9%)(χ2 =10.594,P=0.001).The treatment duration,the period of temperature returning to normal,the period of fever before and after treatment,the period of recovery between the two groups were statistically significant different(all P＞0.05).Conclusions Whether or not using antibiotics has no impact on prognoses.The antibiotics should be used selectively according to the risk of influenza complication and the result of rapid diagnoses of influenza.