中国医科大学学报

中国医科大学学报
  • 中文核心期刊
  • 中国科技核心期刊
  • 中国高校百佳科技期刊
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中国医科大学学报 ›› 2018, Vol. 47 ›› Issue (5): 406-410,414.doi: 10.12007/j.issn.0258-4646.2018.05.006

• 论著 • 上一篇    下一篇

病原学阳性与阴性的医院获得性肺炎患者临床特征及预后比较

刘晓1, 王彤2, 蒋怡芳3, 王媛1   

  1. 1. 河北医科大学第四医院感染管理科, 石家庄 050011;
    2. 河北医科大学第四医院胸外科, 石家庄 050011;
    3. 河北医科大学第四医院 呼吸内科, 石家庄 050011
  • 收稿日期:2017-06-29 出版日期:2018-05-30 发布日期:2018-04-27
  • 通讯作者: 刘晓 E-mail:liuxiao0121@126.com
  • 作者简介:刘晓(1982-),女,主治医师,硕士.
  • 基金资助:
    河北省医学科学研究重点课题(20150316)

Comparison of Clinical Characteristics and Outcomes of Patients with Culture-negative versus Culture-positive Hospital Acquired Pneumonia

LIU Xiao1, WANG Tong2, JIANG Yifang3, WANG Yuan1   

  1. 1. Department of Hospital Infection Management, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China;
    2. Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China;
    3. Department of Respiration, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
  • Received:2017-06-29 Online:2018-05-30 Published:2018-04-27

摘要: 目的 探讨病原学阳性与阴性的医院获得性肺炎(HAP)患者临床特征以及预后的差异。方法 收集2015年1月至2016年12月HAP患者临床资料,采集确诊患者第1天、第3天、第5天血液标本,测定白细胞、C-反应蛋白、降钙素原、B型钠尿肽与乳酸水平。患者随访至死亡或自诊断HAP起90 d。结果 共纳入161例HAP患者,病原学阳性86例,病原学阴性75例。病原学阴性组与阳性组比较PaO2/FiO2更高(P=0.012),机械通气(MV)时间更短(P < 0.001)。2组患者确诊后第1天、第3天、第5天血清学标志物均无统计学差异(P > 0.05)。与病原学阳性组比较,病原学阴性组经验治疗方案改变率低(P < 0.001),具有较短的抗菌治疗时间(P=0.001)与住院时间(P=0.001),住院病死率低(P=0.042);2组28 d与90 d病死率无统计学差异(P > 0.05)。结论 病原学阴性HAP患者具有较高PaO2/FiO2,MV、住院、抗菌治疗时间均较短,住院病死率低。

关键词: 病原学, 医院获得性肺炎, 临床特征, 预后

Abstract: Objective To compare the clinical characteristics and outcomes of patients with and those without microbiologically confirmed hospital-acquired pneumonia(HAP).Methods Clinical data of patients with HAP from January 2015 to December 2016 were collected. The white blood cell(WBC)count and serum levels of C-reactive protein(CRP),procalcitonin(PCT),B-type natriuretic peptide(BNP),and lactic acid(LAC)were determined on days 1,3,and 5 after the diagnosis of HAP. All patients were followed uptill death or 90 days after diagnosis.Results A total of 161 HAP patients were included in the study;86 had culture-positive while 75 had culture-negative HAP. Culture-negative patients had higher PaO2/FiO2 ratios(P=0.012)and a shorter duration of mechanical ventilation(MV,P < 0.001)compared with culture-positive patients.There was no significant difference between the two groups in the WBC count and CRP,BNP,and LAC levels at 1,3,and 5 days(P > 0.05). The culture-negative group had fewer changes in empiric treatment (P < 0.001),a shorter duration of antibacterial treatment(P=0.001),shorter hospital stay(P=0.001),and lower hospital mortality(P=0.042). There was no significant difference between groups in the 28-and 90-day mortality.Conclusion Culture-negative HAP was associated with higher PaO2/FiO2 ratios,shorter duration of MV and antibacterial treatment,shorter hospital stay,and lower hospital mortality.

Key words: microbiology, hospital-acquired pneumonia, clinical characteristics, outcome

中图分类号: 

  • R563.1
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