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目的观察初始治疗是否充分对社区获得性胸腔细菌感染患者临床转归的影响。方法回顾性病例分析收集符合英国胸科医师协会胸腔细菌感染诊断标准的急性社区获得性胸腔感染患者,按是否给予充分的初始抗生素及胸腔积液引流联合治疗分为初始充分治疗组(31例)和初始未充分治疗组(17例),比较两组临床表现、炎症指标及住院天数和住院费用的差别。结果两组间年龄、性别、胸腔感染部位、伴发基础疾病等一般情况无统计学差异(P均>0.05)。初始充分治疗组体温较初始未充分治疗组下降更快,在治疗后第5、6、7 d与初始未充分治疗组比较,差异有统计学意义[(37.4±0.1)℃比(38.3±0.2)℃,P<0.001;(37.4±0.1)℃比(37.9±0.1)℃,P<0.05;(37.4±0.1)℃比(38.1±0.2)℃,P<0.01]。治疗后6周内,两组白细胞计数、中性粒细胞百分比及血沉的变化无明显差异(P均>0.05),初始充分治疗组在治疗第1周时C反应蛋白(CRP)较初始未充分治疗组显著降低[(123.1±13.8)mg/L比(182.7±25.3)mg/L,P<0.05]。初始充分治疗组较初始未充分治疗组住院花费显著减少[(28 367±3 328)元比(43 334±7 134)元,P<0.05],住院时间也显著缩短[(25±4)d比(34±4)d,P<0.05]。结论初始选择正确的抗生素并联合充分有效的胸液引流可以使患者体温及CRP更快地下降,从而降低住院花费、缩短住院时间。治疗5 d体温是否低于37.5℃以及CRP是否明显下降是评价初始治疗效果的敏感指标,有助于指导下一步治疗措施。
Objective To observe the effect of initial treatment on the clinical outcome of patients with community-acquired pleural bacteria infection. Methods Retrospective case analysis Acute community-acquired thoracic infections in line with the British Thoracic Society diagnostic criteria for thoracic bacterial infections were enrolled and divided into initial adequate treatment group (31 patients) with adequate initial antibiotic and pleural effusion combined therapy. And initial under-treatment group (17 cases). The differences of clinical manifestations, inflammation indexes, hospitalization days and hospitalization costs between the two groups were compared. Results There were no significant differences between the two groups in general conditions such as age, sex, location of chest infection and underlying diseases (all P> 0.05). Compared with the initial under-treatment group, the body temperature in the initial adequate treatment group decreased more rapidly than that in the initial under-treatment group, and the difference was statistically significant [(37.4 ± 0.1) ℃ vs (38.3 ± 0.2 ), P <0.001; (37.4 ± 0.1) ℃ vs (37.9 ± 0.1) ℃, P <0.05; (37.4 ± 0.1) ℃ vs (38.1 ± 0.2) ℃, P <0.01]. Within 6 weeks after treatment, the change of white blood cell count, neutrophil percentage and erythrocyte sedimentation rate in the two groups had no significant difference (all P> 0.05). In the first full treatment group, C-reactive protein (CRP) The treatment group was significantly lower [(123.1 ± 13.8) mg / L (182.7 ± 25.3) mg / L, P <0.05]. Hospitalization costs were significantly lower in the initial adequate treatment group compared with those in the initial under-treatment group [(28 367 ± 3 328) yuan (43 334 ± 7 134) yuan P <0.05], and hospital stay significantly shorter (25 4 days (34 ± 4) d, P <0.05]. Conclusion The initial selection of the right antibiotics combined with adequate and effective drainage of pleural fluid can decrease the temperature and CRP of the patients more quickly, thus reducing the hospitalization expenses and shortening the hospitalization time. Treatment of 5 d body temperature is lower than 37.5 ℃ and CRP is a significant reduction in the evaluation of the initial treatment of sensitive indicators to help guide the next step of treatment.