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1、社区获得性肺粉病情及预后评估介绍JinchulRucom志社区获得性肺炎伽m叩响叫岫dpem。ma,cP)是指-在医院外罹患一肺实质的感染性炎症-也包括在平均潜伏期内、入院后发病的病例医Mansymptomsofinteclous瓢_PneumoniaSystemic:-Highfevercentral:-chilis-Headaches-LossofappetteSkin:-Moodswngs-clanminess-BlenessVascularEmos-Lowbloodpressure-coughwithsputumorHeartphlegm-Hghheatnate-Shorinsssfi
2、rsat-pleunticicchestpainN-HenopgsisMuscular-Fatgue.-AchesCAP临床诊断依据*新近出现的咳嗽、咳痰,或原有呼吸道疾病疳状加重,并出现脓性痰;伴或不伴胸痛。发热。肺实变体征和(或)湿性罗音WBC10X109/L或28/min220.8HR2100bpm160.7肺郯发现吁诊泡音河8有8刀一市咖吸音凑能|53万人“支气管昱吸音33NShegophony41NS浜罗音2008善怒音NSNSeUeabeegiuauE2szoumgmy河一凭实验室及临床资料对CAP的诊断。BeatMuller分析373例肺炎确诊病人一依据临床症状及体征如发热(T3
3、7.9“C)、咳嗽、咳疸、气促及肺部听诊异常诊断CAP的模型的AUC为0.79(95%Cl0.75-0.83)一该模型加上hsCRP40mgyL,AUC值升高至0.90(95%Cl0.87-0.93)一该模型加上PCT0.1ug/L,AUC值为0.88(95%Cl0.85-0.91)-该模型同时加.ChsCRP40ma心及PCT0.1ug/l,AUC值为0.92(95?%Cl0.89-0.94)Dggnosteandpgrostcsceumeyolcincalandlbomoopaameeesincommunigacqbnedpeunonias“BVCIneaomDeessesa0o7.76,
4、最高可达15%的住院病人面临首次治疗失败,6%呈现出现快速进展,约5-1096CAP病人需进入ICU治疗“总的死亡率为5-10%,其中住院病人死亡率10-15%,重症肺炎死亡率在35%以上“死亡率随着年龄增大而增加,65岁以上老年人死亡率明显增加ao25SEicstalTheray2009542062-1069zo一雪咤宇aS3.oa二西井引。18-19Zo2e30394o-49_5o-596o-697o-7eao-s9“eo,Ageclass页L口ag5一CAP严重性及预后评估系统。PSUPORT。CURB-65,CRB-65,DSCRB-65A-DROP。CORB。SMART-COP。RE
5、A-ICU。SAP。ATS/IDSA2007*其他:PIRO、CURSI、SOFA等yMeorpoweAssouoAestmymn技Aentnyn-erngherereseon+naganyqqae丁g。yoonsologoposcaonnne1Dnsrseeore1上N曹congosyehenions46Copooseitrdeeane1DomsyepmierthssahiaoyManaldoeane6PndoeconpWpicaioeoinatoncowotgcerdteneeoponcdeooneEc谚aRopeeeanmn1wy训s谦botendondeonphicnenor玉Nhnetalptc78543rSoogeanpeoonsomoe1Domraritehezayisnedclenpasnenygnlguma1copectaeecatceGoestesgogit0tndfien+Anondmeralaute+nnzamPonisipesueea6SrolceatpeunERNJircsleflson6PinsnnSnofesionolhescomssonpsettignpotmtiosE|医一frWeryaseod|netl9wnee|n3pndetona|hv寇
