摘要
目的分析重症社区获得性肺炎(SCAP)耐药菌及死亡因素,同时探究中药治疗对其病死率的影响。方法采取回顾性研究的方法,收集符合标准的2016年6月—2019年6月江苏省中医院急诊中心收治确诊的SCAP病例资料,统计分析并比较痰培养资料,分析影响死亡因素。并在所有“死亡”结局的病患中,根据住院期间口服中药是否80%及以上时间参与治疗为中药组,无中药参与治疗的为对照组,分析中药治疗对SCAP预后及生存时间的影响。结果共纳入研究病例219例,其中死亡64例,生存155例,发现183株耐药菌,革兰氏阴性菌为主,占68.8%,以鲍曼不动杆菌为主,占20.2%,而主要的革兰阳性菌为金黄色葡萄球菌,占10.2%。其中,恶性肿瘤病史(OR=3.474)、肾功能不全(OR=3.278)、中药治疗(OR=2.448)为影响SCAP死亡的因素(P<0.05)。在64例死亡病例中,中药组22例,对照组42例,在排除混杂因素后,Kaplan-Meier生存曲线分析显示中药组28天病死率低于对照组,根据Log Rank比较,差异有统计学意义(P=0.013)。结论革兰氏阴性菌是SCAP的主要致病菌,且耐药率较高。恶性肿瘤及肾功能不全可增加SCAP死亡的风险,中药干预治疗可减少死亡风险,延长住院生存时间,对SCAP的治疗预后有着积极的临床意义。
Objective To analyze drug-resistant bacteria and death factors of severe community acquired pneumonia(SCAP),and explore the influence of Chinese medicine(CM)treatment on the death rate of SCAP.Methods A retrospective study was conducted to collect the data of confirmed SCAP cases admitted to the Emergency Center of Jiangsu Hospital of Chinese Medicine from June 2016 to June 2019.The sputum culture data were statistically analyzed and compared to analyze the mortality factors.In addition,all patients with"death"outcome were defined as the CM group according to whether oral CM participated in treatment for 80%or more of the time during hospitalization,and those without CM participated in treatment were defined as the control group.The effects of CM treatment on the prognosis and survival time of severe pneumonia were analyzed.Results A total of 219 cases were included,among which 64 died and 155survived.Totally 83 strains of drug-resistant bacteria were found,mainly Gram-negative bacteria,accounting for 68.8%,Acinetobacter baumannii,accounting for 20.2%,and Staphylococcus aureus,the main Gram-positive bacteria,accounting for 10.2%.Among them,the history of malignant tumor(OR=3.474),renal insufficiency(OR=3.278),CM treatment(OR=2.448)were the influencing factors of SCAP death(P<0.05),among the 64 cases of death,there were 22 cases in the CM group and 42 cases in the control group.After the exclusion of confounding factors,Kaplan-Meier survival curve analysis showed that the 28-day mortality in the CM group was lower than that in the control group,and the difference was statistically significant according to Log Rank(P=0.013).Conclusions Gram-negative bacteria is the main pathogenic bacteria of SCAP,and the drug resistance rate is high.Malignant tumor and renal insufficiency can increase the risk of death from severe pneumonia.CM intervention can reduce the risk of death and prolong the survival time in hospital,which has positive clinical significance for the treatment and prognosis of SCAP.
作者
袁思成
黄肖玲
华胜毅
周运航
芮庆林
YUAN Si-cheng;HUANG Xiao-ling;HUA Sheng-yi;ZHOU Yun-hang;RUI Qing-lin(Emergency Department,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029)
出处
《中国中西医结合杂志》
CAS
CSCD
北大核心
2022年第3期305-310,共6页
Chinese Journal of Integrated Traditional and Western Medicine
基金
江苏省自然科学基金资助项目(No.YB201813)
江苏省中医药局中医重点学科项目(No.K2013XKO3)。
关键词
重症社区获得性肺炎
耐药菌
痰热蕴肺
中药治疗
住院生存时间
回顾性研究
severe community acquired pneumonia
drug-resistant bacteria
phlegm-heat accumulation Fei
Chinese medicine treatment
hospital survival time
retrospective study
