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目的 试图找出针对慢性阻塞性肺病 (COPD)急性发作患者合适的抗菌治疗策略。方法 根据SepsisScore(SS)评分 ,对 4 7例接受过NIPPV治疗的COPD急性发作患者进行肺部感染严重度的评分 ,并依据治疗效果和支气管—肺泡灌洗液细菌学检测结果评价抗菌治疗是否充分 ,以及对临床转归的影响。结果 监测COPD急性发作期患者的SS ,发现当SS≤10时 ,充分的经验性抗菌治疗可明显降低死亡率 ;但是 ,当SS积分 >10时 ,抗菌治疗策略并不能明显改善患者的预后。结论 根据COPD急性发作患者感染严重度 ,早期采取相应抗菌治疗策略 ,可降低死亡率并防止滥用抗菌药物
OBJECTIVE: To find a suitable strategy for antimicrobial therapy in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods Seventy-seven patients with acute exacerbation of COPD who underwent NIPPV-based therapy were scored for severity of pulmonary infection based on the SepsisScore (SS) score and evaluated for adequate antimicrobial therapy based on the efficacy of treatment and bacteriological examination of bronchoalveolar lavage fluid , And the impact on clinical outcome. Results Monitoring SS in patients with acute exacerbation of COPD found that adequate empirical antibiotic therapy significantly reduced mortality when SS ≤ 10; however, when the SS score> 10, antimicrobial therapy did not significantly improve patient outcomes. Conclusions According to the severity of infection in patients with acute exacerbation of COPD, early antimicrobial therapy strategies may reduce mortality and prevent the abuse of antimicrobial agents