目的 观察社区获得性肺炎(CAP)患者的抗生素使用情况和治疗效果.方法 入选2011年3月至2014年3月在山西省临汾市人民医院住院确诊并诊治的362例CAP患者,依据是否遵循指南推荐的抗感染治疗方案,将患者分为观察组(209例)与对照组(153例).观察组采用β内酰胺类联合大环内酯类或喹诺酮类抗生素治疗,对照组采用单一β内酰胺类或单一大环内酯类抗生素治疗.比较2组患者病原菌的构成、抗生素使用情况、临床疗效(包括体温恢复正常时间、治疗第3天和第7天的白细胞计数、中性粒细胞计数、治疗第7天胸部X线片或CT中斑片影的变化情况)和住院时间.结果 ①2组患者共培养出病原菌90株,观察组56株,对照组34株,包括肺炎链球菌、肺炎支原体、金黄色葡萄球菌、肺炎衣原体、军团菌、卡他莫拉菌.应用单一抗生素148例(40.9％),2种抗生素联合应用193例(53.3％),3种抗生素联合应用21例(5.8％).②观察组患者体温恢复正常的时间[(3.5±1.7)d]较对照组[(5.6±2.4)d]短,差异有统计学意义(P＜0.05).③治疗第3、7天时,观察组白细胞计数、中性粒细胞计数均较对照组明显改善[第3天:(8.2±1.7)、(7.6±3.1)×109/L比(9.9±2.3)、(8.4±5.1)×109/L,第7天:(6.3±1.6)、(5.4±2.3)×109/L比(8.2±1.8)、(7.1±3.0)×109/L],差异有统计学意义(P＜0.05).④治疗第7d时复查胸部X线片或胸部CT,观察组肺部斑片影面积缩小有效率[78.0％ (163/209)]高于对照组[59.5％ (91/153)],差异有统计学意义(P＜0.05)..⑤观察组患者住院时间[(11±3)d]较对照组[(16±6)d]缩短,差异有统计学意义(P＜0.05).结论 遵循指南推荐的抗感染治疗方案治疗CAP,患者体温、白细胞计数、中性粒细胞计数恢复正常的时间短,肺部斑片影面积缩小快,住院时间短,治疗失败率和病死率低,临床疗效更好.%Objective To observe the therapeutic efficacy of antibiotics in treatment of community acquired pneumonia (CAP).Methods Three hundred and sixty-two CAP patients from March 2011 to March 2014 were collected and divided into observation group (209 cases) and control group (153 cases) according to whether following the guideline of anti-infection treatment scheme or not.The patients were given β-1actam combined with macrolide or quinolone antibiotic in observation group,and were given singleβ-1actam or single macrolide antibiotics in control group.The pathogens,drug using,efficacy (including the temperature recovery time,white blood cell and neutrophil count on the third and seventh day after treatment,changes of the shadows on the X-ray or CT images) and hospitalization time were compared between the two groups.Results Totally 56 pathogens in observation group and 34 pathogens in control group were cultured,including streptococcus pneumoniae,mycoplasma pneumoniae,pseudomonas aeruginosa,klebsiella pneumoniae,staphylococcus aureus,acinetobacter baumannii,chlamydia pneumoniae,legionella,moraxella catarrhalis and feces enterococcus.Totally 148 cases (40.9％) were given single antibiotic,193 cases (53.3％) were given two kinds of antibiotics,and 21 cases (5.8％) were given three kinds of antibiotic.The temperature recovery time in observation group was significantly shorter than that in control group [(3.5±1.7) d vs (5.6 ±2.4)d,(P ＜0.05)];on the third and seventh day after treatment,the white blood cell and neutrophil counts in observation group were significantly decreased compared with those in control group the third day:(8.2±1.7),(7.6 ±3.1) x 109/L vs (9.9 ±2.3),(8.4 ±5.1) x 109/L,the seventh day:(6.3 ± 1.6),(5.4 ± 2.3) x 109/L vs (8.2 ± 1.8),(7.1 ± 3.0) x 109/L,P ＜0.05);the reduction rate of the shadows on the X-ray or CT images on the seventh day after treatment in observation group was significantly higher than that of control group [78.0％ (163/209) vs 59.5％ (91/153),P ＜ 0.05].The length of hospitalization time in observation group was shorter than that in control group [(11 ± 3) d vs (16 ± 6) d,P ＜ 0.05].Conclusions In treatment of CAP,the temperature,white blood cell and neutrophil count,abnornral imaging require shorter time of recovery and hospitalization tine was also reduced by following the guideline of anti-infection treatment scheme.
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