摘要目的 探讨遵循IDSA/ATS社区获得性肺炎(CAP)诊治指南对治疗失败率的影响.方法 纳入2010年3月至2012年2月天津地区10家医院收治的668例CAP患者,并依据是否遵循2007年IDSA/ATS CAP指南选择抗菌素分组.治疗期间每日监测体温、心率、呼吸频率及血氧饱和度等指标.患者应用抗菌素72 h,达不到如下稳定状态指标被定义为治疗失败:体温≤37.8℃；心率≤100次/min;呼吸≤24次/min;收缩压≥90 mm Hg;呼吸室内空气条件下SaO2≥90％或PaO2≥60 mm Hg;能够口服进食.结果 遵循指南组和未遵循指南组CAP患者治疗失败率分别是30.7％和38.2％,二者之间差异有统计学意义(P＜0.05)；年龄≥65岁组、伴基础疾病组、入院前未用抗菌素组中,遵循指南组与未遵循指南组治疗失败率分别是32.4％和43.9％、30.8％和40.8％、22.6％和34.9％,二者之间差异均有统计学意义(P值均＜0.05).结论 遵循IDSA/ATS CAP指南选择抗菌素可以降低治疗失败率.

abstractsObjective To analyze the effects of IDSA/ATS guideline of community-acquired pneumonia (CAP) on treatment failure rate.Methods The data of 668 CAP patients collected from ten hospitals admitted from March 2010 to February 2012 were analyzed.The patients were grouped according to the IDSA/ATS CAP guideline (2007 update).The body temperature (T),heart rate (HR),respiratory frequency (R),and saturation of blood oxygen (SaO2) were monitored.The patients who used antibiotics for 72 hours and could not reach the stable conditions as follows were defined treatment failure:T≤ 37.8 ℃,HR≤ 100 beats/min,R≤24 breaths/min,systolic blood pressure≥ 90 mm Hg,SaO2≥90％ or PaO2 ≥ 60 mm Hg on room air,ability to maintain oral intake.Results There was difference in the treatment failure rate of CAP between the patients who abided by guideline to select antibiotics and the patients who did not abide by guideline (30.7％ vs 38.2％,P ＜0.05).In age≥65 years group,with basic diseases group,prehospital unused antibiotics group,there was difference in the treatment failure rate of CAP between the patients who abided by guideline to select antibiotics and the patients who did not abide by guideline (32.4％ vs 43.9％,30.8％ vs 40.8％,22.6％ vs 34.9％,respectively,P ＜ 0.05).Conclusions Following the IDSA/ATS guideline can decrease the treatment failure rate of CAP.