Treatment of pneumonia
Among human infectious diseases, pulmonary infection is the most common, and three quarters of all antibiotics are used for respiratory tract treatment, among which the ratio of community-acquired infection to nosocomial infection is 4: 1, and the drug resistance of the latter far exceeds that of the former. In outpatient and emergency departments, medical staff's "medication by experience" and some moderate and severe patients are prone to cause new infections after hospitalization (the national standard for controlling iatrogenic infections is 15%, while that in the United States is 5%), which makes the treatment of pulmonary infections enter an embarrassing situation of high cost and poor effect. As long as clinicians can carry out necessary laboratory tests, more than 80% of pneumonia patients actually do not need hospitalization. With the popularization of cefdinir, the hospitalization phenomenon that increases the cost, increases the mental burden of patients and increases the chances of other nosocomial infections is expected to change.
The average hospitalization days of pneumonia patients in Tianjin are 22.7 days, and the average hospitalization medical expenses are 7 173.8 yuan.
The per capita hospitalization expenses of children with pneumonia were 2596.94 yuan, the cost of medicine 1298.43 yuan, the cost of using antibiotics was 862.68 yuan, and the average hospitalization days 12.95 days.
There are 200-300 million children in China, accounting for 30% of the population. It is necessary to increase investment, improve grades and deepen added value.
Development degree (drug delivery device)
Community acquired pneumonia (CAP) refers to the inflammation of pulmonary parenchyma (including alveolar wall, that is, interstitial lung in a broad sense) outside the hospital, including pneumonia caused by pathogen infection with a clear incubation period, which occurs within the average incubation period after admission. In today's antibiotic era, CAP is still an important disease that threatens people's health, especially because of the aging of social population, the increase of immunocompromised hosts, the change of pathogens and the increase of antibiotic resistance rate, CAP is facing many new problems.
First, the clinical diagnosis basis of CAP
1. Cough and expectoration recently, or the symptoms of original respiratory diseases are aggravated, and sputum is taken; Any chest pain.
2. Have a fever.
3. Lung consolidation and/or wet rales.
4.WBC & gt 10× 109/ l or
5. Chest X-ray examination showed patchy or patchy infiltrative shadows or interstitial changes, with or without pleural effusion.
Second, the etiological diagnosis of CAP
Collection, examination and laboratory treatment of sputum bacteriological examination specimens: Sputum is the most convenient and non-invasive pathogen diagnosis specimen, but expectoration is easily contaminated by bacteria in oropharynx. Therefore, the quality of sputum samples, whether the inspection is timely and the quality control of the laboratory directly affect the isolation rate of bacteria and the interpretation of the results, which must be standardized. (1) Collection: Specimens must be collected before antibiotic treatment. Let the patient cough first, and instruct or assist the patient to cough deeply, and take oral sputum for inspection. Mycobacterium and Pneumocystis carinii can be detected in sputum-free patients, which can be induced by atomizing hypertonic saline. Three early morning sputum samples should be collected for fungal and mycobacterial examination; For common bacteria, it is necessary to conduct cytological screening on the specimen first, 1 time. (2) Submit for inspection: Submit for inspection as soon as possible, no more than 2h. Delayed inspection or samples to be processed should be stored at 4℃ (suspected streptococcus pneumoniae infection is not included), and the stored samples should be processed within 24 hours. (3) Laboratory treatment: select purulent smear for Gram staining, and select qualified specimens (squamous epithelial cells: 25/ low power field, or the ratio of the two)
Third, the assessment of the severity of CAP Many factors increase the severity of CAP and the risk of death. In case of one of the following circumstances, especially when the two situations coexist, it is recommended to be hospitalized conditionally.
1. Age > 65 years old. 2. There are underlying diseases or related factors: ① chronic obstructive pulmonary disease; ② Diabetes; ③ Chronic cardiac and renal insufficiency; ④ Inhalation or easy inhalation factors; ⑤ recent 1 year CAP hospitalization history; ⑥ mental state change; ⑦ State after splenectomy; ③ Chronic drunkenness or malnutrition.
3. Abnormal signs: ① Respiratory frequency >; 30 beats /mim② Pulse ≥ 120 beats /mim③ Blood pressure < 90/60mmhg (1mmhg = 0.133kpa); ④ The body temperature should be injected at 40℃ or < 35℃; ⑤ Consciousness disorder; ⑥ Extrapulmonary infections such as septicemia and meningitis.
4. Laboratory and imaging abnormalities: ① WBC >; 20× 109/ l, or
The following symptoms are mostly manifestations of severe pneumonia, which requires close observation and active treatment.
1. Consciousness disorder.
2. respiratory rate > 30 beats/min
3.Pa & lt60mmHg、Pa O2/Fi02 & lt； 300, need mechanical ventilation treatment.
4. Blood pressure