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目的了解临床医师对社区获得性肺炎诊断和治疗指南(简称指南)的认识、执行情况以及是否按照指南诊治对预后的影响。方法在北京6家医院的医生中进行对指南的认识以及实施情况的问卷调查,同时回顾性分析2002年1月1日至2003年12月31日北京5家医院因社区获得性肺炎(CAP)住院的490例患者的资料,结合指南对其经验性治疗及转归进行分析。结果发放问卷250份,收回224份,回收率为89.6%,有效问卷210份。除了肺炎链球菌,大多数医生对其他病原体,特别是非典型病原体在 CAP 中的地位认识很局限。被调查的呼吸科医生中按照中华医学会呼吸病学分会制定的指南进行诊治的仅占46.0%(97/210)。82.4%(173/210)的医生根据具体情况有选择地给予初始经验性用药。79.5%(167/210)的医生常规进行病原学检查,84.3%(177/210)的医生认为病原学检查对选用抗生素很有帮助。被调查的490例病例中,非典型病原体感染占6.7%(33/490)。初始经验性治疗总有效率为84.5%(414/490),与中华医学会呼吸病学分会指南和美国胸科学会(ATS)指南所建议的初始治疗方案相符合的病例分别占46.7%(229/490)和26.7%(131/490)。按照指南治疗和不按照指南治疗的有效率比较无明显区别。依据病原学治疗与不依据病原学治疗的治愈率没有明显区别。结论真正按照中华医学会呼吸病学分会指南进行分组治疗的患者所占比例较小,然而绝大多数患者治愈,按照与不按照指南治疗的有效率没有明显区别;抗生素有过度应用之嫌,需要进一步推进指南的应用。
Objective To understand the clinicians’ understanding of the diagnosis and treatment of community-acquired pneumonia (referred to as guidelines), the implementation and the impact of diagnosis and treatment according to the guidelines on the prognosis. Methods The doctors of 6 hospitals in Beijing conducted a questionnaire survey on the guidelines and their implementation status. At the same time, retrospectively analyzed the prevalence of community-acquired pneumonia (CAP) in 5 hospitals in Beijing from January 1, 2002 to December 31, Inpatient 490 patients, combined with guidelines for their empirical treatment and outcome analysis. Results The questionnaire was distributed 250 copies, 224 copies, the recovery rate was 89.6%, 210 valid questionnaires. With the exception of S. pneumoniae, most physicians have a limited understanding of the status of other pathogens, especially atypical pathogens in CAP. Among the surveyed respiratory physicians, only 46.0% (97/210) were diagnosed and treated according to the guidelines set by the Respiratory Disease Branch of Chinese Medical Association. 82.4% (173/210) doctors were given initial empirical medication as the case may require. 79.5% (167/210) of doctors routinely conduct etiological examination, and 84.3% (177/210) of doctors think that etiological examination is very helpful for the selection of antibiotics. Among the 490 cases investigated, atypical pathogens accounted for 6.7% (33/490). The total effective rate of initial experience treatment was 84.5% (414/490), which was 46.7% (229.7%) corresponding to the initial treatment plan recommended by the guidelines of the Chinese Medical Association Respiratory Disease Branch and the American Thoracic Society (ATS) / 490) and 26.7% (131/490). There was no obvious difference in the efficiency of treatment according to the guidelines and failure to follow the guidelines. There was no significant difference in the cure rates based on etiological and non-etiological treatments. Conclusions The proportion of patients treated according to the guidelines of the Respiratory Disease Branch of the Chinese Medical Association is relatively small. However, the vast majority of patients are cured with no significant difference in the efficiency of treatment according to the guidelines or not. The excessive use of antibiotics is suspected Further promote the application of the guide.