成人社区获得性肺炎患者住院时间的影响因素分析

目的综合分析影响成人社区获得性肺炎（CAP）患者平均住院时间的临床及非临床因素。方法回顾性分析2002年1月至2006年1月我院收治的成人CAP患者的临床资料，根据Fine危险分级标准分为低危组（Ⅰ～Ⅲ级）和高危组（Ⅳ～Ⅴ级）。分析2组住院时间延长者的影响因素。结果共计302例成人CAP患者人选。其中111例（36．8％）处于Fine危险分级Ⅰ～Ⅲ级，191例（63．2％）处于Ⅳ～Ⅴ级。总体住院时间2～47d，平均10．5d。Ⅰ～Ⅲ级的低危患者平均住院时间7．5d，Ⅳ～Ⅴ级高危患者为11．5d。肺炎相关因素和非临床因素导致住院时间延长的患者比例在低危组显著高于高危组（P〈0．05）。而出现并发症和基础疾病恶化导致住院时间延长的患者比例在高危组显著高于低危组（P〈0．05）。结论目前我国成人CAP患者的平均住院时间仍高于国外水平。除了稳定基础疾病和防治并发症外，必须捉商医疗服务质量，减少非临床因素导致的非必要住院时问。

Factors impacting on length of stay of community acquired pneumonia

Objectives To evaluate the causes of prolonged length of stay in patients with community-ac-quired pneumonia(CAP) based on Fine risk classes. Methods A retrospective cohort analysis was performed for adult patients hospitalized with CAP between January 2002 and January 2006. According to low (classes Ⅰ, Ⅱ,Ⅲ) or high(classes Ⅳ, Ⅴ) risks, the target duration of hospitalization was set up as 7 and 9 days, respectively. Results A total of 302 patients were enrolled with a mean length of stay days of 10.5 days (range 2-47 days). 111 cases(36.8% ) were in Ⅰ-Ⅲ risk class(low risk class) and 191 (63.2%) were in Ⅳ-Ⅴ risk class(high risk class). Causes of prolonged hospitalization were related mainly to pneumonia (30%) in all risk classes. Morbid complications and instability of the underlying diseases were more in high risk class patients than those in low risk class. Nonclinical factors were more common in low risk class patient than those in high risk class. Conclusions The causes of prolonged hospitalization of patients with CAP are multifactorial, depending mainly on pneumonia and comorbid conditions. There is unnecessary hospitalization that could be reduced by improving the efficiency of hospi-tal care.