初始抗生素合理应用对重症肺炎患者预后的影响

目的：探讨初始抗生素的合理应用对重症肺炎的治疗效果和对预后的影响。方法：对53例重症肺炎患者的临床资料进行回顾性研究，分析患者初始抗生素应用情况、初始痰培养和药敏试验结果、机械通气和住ICU时间、总费用和病死率。结果：45例初始培养阳性患者中，初始抗生素合理使用率62．2％（28／45）；初始抗生素合理使用组和不合理组患者抗生素使用时间（10．7±3．6）d和（17．5±5．1）d]、机械通气时间（9．1±4．9）d和（14．9±6．7）d]、住ICU时间（15．4±5．2）d和（20．6±5．9）d]和总费用（57191．5±370．2）元和（82726．6±320．3）元]比较，差异均有统计学意义（P〈0．05）；两组患者病死率（10．7％和23．5％）的差异无统计学意义（P〉0．05）。结论：加强初始抗生素的合理应用以及对细菌耐药的监测，可缩短重症肺炎患者病程、改善预后，对减轻重症肺炎患者的医疗费用有一定的意义。

Analysis of prognosis of initial antimicrobial therapy for pneumonia

Objective： To explore the effects and prognosis of appropriate initial antimicrobial therapy in patients with severe pneumonia. Methods： A random sample of 53 cases with severe pneumonia were retrospectively studied in intensive care unit（ICU） ,including 14 cases with community-acquired pneumonia（CAP） and 39 cases with hospital-acquired pneumonia（HAP）. Initial antimicrobial therapy, initial sputum culture, bacterial sensitivity, days of mechanical ventilation, length of stay, hospitalization costs and mortality were analyzed. Results： Of 45 cases whose initial sputum culture were positive, 28 patients received appropriate initial antimicrobial therapy （AIAT,62. 2% ）. Days of antibiotic therapy （ 10. 7 ± 3.6） d vs （ 17. 5 ± 5.1 ） d] and mechanical ventilation （9. 1 ±4. 9）d vs（ 14. 9 ± 6.7）d] ,length of stay （ 15.4 ±5.2） d vs （20. 6±5.9） d] and hospitalization costs （57 191.5 ± 370.2） yuan vs （82 726.6 ±320.3） yuan] in AIAT group and IIAP （inappropriate initial antimicrobial therapy） group were significant different （P 〈 0. 05 ）, although mortality（ 10. 7% vs 23.5% ） between two groups was not statistically significant （P 〉0. 05）. Conclusion： It is suggested that rational initial antimicrobial therapy and a forceful surveillance of bacterial resistance can reduce length of stay and hospitalization costs, and ameliorate prognosis.