The Analysis Of44Cases With Severe Community-acquired Pneumonia

Severe community-acquired pneumonia (SCAP) is a common serious illness in the respiratory medicine. Due to reducing the body’s defenses, an aging population, and the rise of antibiotic resistance to pathogen change, SCAP is the illness with a high disease incidence, mortality, and the medical resource consumption of the disease. At present, how to reduce the case fatality rate of SCAP and improve prognosis, clinical doctors still face many severe challenges. Thus, accurate assessment of risk factors in the SCAP patients, summarizing the etiology and treatment plan will help clinical doctors to judge the disease and prognosis of the patients, to improve the success rate of the treatment and reduce mortality.ObjectiveWe retrospectively analyzed to investigate the risk factors for SCAP, etiology and rational antibiotic treatment in order to facilitate clinicians quickly making an objective clinical assessment, timely and accurate treatment.MethodsFrom august2007to august2012there are44patients with severe community-acquired pneumonia in the central hospital of JiaoZuo coal group. These patients are analyzed, including male36cases, female9cases, the age20to88, and average age (63±10). Pneumonia severity index score of all patients is greater than91points. All cases were accord with the standard in the diagnosis of severe pneumonia.32cases with age are greater than65.29cases are basic disease including16cases of merger of two or more than two kinds of basic diseases, such as12cases of silicosis,10cases of chronic obstructive pulmonary disease,6cases of hypertension,4cases of cerebrovascular disease,8cases of diabetes,6cases of tumor,3cases of coronary heart disease, respectively.28cases of breathing rate greater than30times per minute,16cases of disturbance of consciousness,25cases of cough phlegm blood sputum,26cases of fever,18cases of temperature not rising,26cases of systolic blood pressure less than90mmHg,27cases of urine less than20ml per hour,23cases of more than two lung infiltrates,19cases of higher than the WBC20x109/L or less than4.0x10/L,21cases of pleural effusion. Vital signs, hemodynamic, blood, urine, stool, serum electrolytes, liver and kidney function, arterial blood, chest X-ray or CT, ECG, cardiac and abdominal ultrasound, etc. of all patients are analyzed. After being hospitalized lower respiratory tract secretion culture are specimen from by bronchoscopy protected specimen brush and nine serums IgM antibody detection of respiratory pathogens infection. After admission,44patients were randomly divided into two groups,22cases in each group. The sex, age, involvement of respiratory failure and lung disease combined basis was no significant difference. The control group uses a class of antibiotics, bacterial culture after disease progression or clear upgrade with broad-spectrum antibiotics is used. The treatment group firstly uses broad-spectrum antibiotics. It then uses the narrow-spectrum antibiotics based on culture results and changes in condition etiology. When atypical pathogens is not except for, respiratory quinolones are combined with, actively correcting respiratory failure(including invasive or non-invasive ventilator), fever, fibrotic bronchoscopy-guided aspiration and lavage, and maintaining blood pressure and acid-base balance. Using SPSS16.0software for data processing, measurement data uses standard deviation (x±s)and compare the differences between the two groups using t test or x2test. Difference is a statistically significant when P<0.05. Results10cases died in32cases of older than65years old and mortality rate is31.3%.9cases died in29cases with basic disease and mortality rate is31%.8cases died16cases of merger of two or more than two basic diseases and the mortality rate is50%.7cases died in28cases of breathing rate greater than30times per minute and is25%.9cases die in16cases of disturbance of consciousness and56.3%.9cases is died in26cases of systolic blood pressure less than90mmHg and the mortality rate is34.6%.8cases died in23cases of more than two lung infiltrates and the mortality rate is34.8%.8cases died in19cases of the higher than WBC20x109/L or less than4.0x109/L and mortality rate by42.1%.12cases were curd and21cases improved in total44patients. Therefore total effective rate was75%.8cases died and3case gave up with follow-up after death. Thus the total mortality is25%.ConclusionPatients with severe community-acquired pneumonia were elder in the majority. Age, basic diseases, involvement of the lung, disturbance of consciousness, and shock, etc. are the risk factors affecting prognosis. The results of sputum culture show that SCAP infection includes a great deal of gram-negative bacteria. Rational antibiotic de-escalation and combination therapy, in conjunction with the comprehensive treatment of sputum suction and alveolar lavage by use of the fiberoptic bronchoscopy, can improve the effectiveness of treatment and reduce mortality.