Comparison of efficacy and disease burden of tracheoscopy intervention in the initial treatment stage of community-acquired pneumonia in four hospitals_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

WANG Peng ¹ , HU Zhenli ² , QIAN Yechang ³ , ZHANG Guoqing ⁴ , LI Xingjing ¹ ,  BAI Chong ²

1. Department of Respiratory Medicine, Baoshan Branch of Shanghai First People’s Hospital, Shanghai Jiao Tong University, Shanghai 200940, P. R. China;
2. Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of the Naval Medical University, Changhai Hospital, Shanghai 200433, P. R. China;
3. Department of Respiratory Medicine, Baoshan Integrated Traditional Chinese and Western Medicine Hospital, Shanghai 201900, P. R. China;
4. Department of Respiratory and Critical Care Medicine, Shanghai First People’s Hospital, Shanghai Jiao Tong University, Shanghai 200080, P. R. China;

Corresponding author：

BAI Chong, Email: bc7878@sohu.com

Keywords：

Community-acquired pneumonia; Initial treatment period; Tracheoscopy intervention; Burden of disease

DOI：

10.7507/1671-6205.201905067

Video：

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Objective To explore the efficacy of community-acquired pneumonia (CAP) by tracheoscopy intervention altimeter and analyze and compare its financial burden.Methods Retrospective analysis of 419 hospitalized patients with CAP was carried in respiratory medicine department of four hospitals from July 1, 2017 to August 31, 2018 (Changhai Hospital, Shanghai First People’s Hospital, Baoshan Branch of Shanghai First People’s Hospital, and Baoshan Integrated Traditional Chinese and Western Medicine Hospital). According to the time of tracheoscopy intervention treatment, they were divided into 3 groups: 127 patients treated with tracheoscopy intervention during the initial treatment period (within 72 h after obtaining imaging diagnosis) were included in an early intervention group, 158 patients treated with tracheoscopy intervention 72 h after obtaining imaging diagnosis were included in a medium-term intervention group, and 134 patients treated without tracheoscopy intervention were included in a non-intervention group. The total efficiency of treatment, improvement of clinical symptoms, imaging absorption, serum inflammation index level, sputum culture positive rate, change rate, efficiency after drug change, hospital stay and hospitalization cost were compared among three groups.Results The total efficiency of treatment in the early intervention group was higher than that of the medium-term intervention group and the non-intervention group, with statistically significant difference (P<0.05), and the time of normality of body temperature, the time of disappearance of strong sputum and cough in the early intervention group, the absorption time of chest X-rays were shorter than that of the medium-term intervention group and the non-intervention group, and the difference was statistically significant (P<0.05); peripheral blood hemoglobin, serum calcitonin and hypersensitive C reactive protein levels were lower than those in the medium-term intervention group and the non-intervention group, with statistically significant differences (P<0.05), and the sputum-positive and drug-change rates in the early intervention group and the medium-term intervention group were higher than those in the non-intervention group, and the difference was statistically significant (P<0.05); the duration of hospital stay in the early intervention group was shorter than that of the medium-term intervention group and the non-intervention group, and the cost of hospitalization was less than that of the medium-term intervention group and the non-intervention group, and the difference was statistically significant (P<0.05).Conclusion Tracheoscopy intervention treatment in the initial period of CAP not only significantly improves the efficacy, but also significantly reduces treatment costs and length of hospitalization, hence it is worth clinical promotion.

Citation： WANG Peng, HU Zhenli, QIAN Yechang, ZHANG Guoqing, LI Xingjing, BAI Chong. Comparison of efficacy and disease burden of tracheoscopy intervention in the initial treatment stage of community-acquired pneumonia in four hospitals. Chinese Journal of Respiratory and Critical Care Medicine, 2020, 19(4): 337-341. doi: 10.7507/1671-6205.201905067 Copy

1.	邹立群, 徐爱晖. 纤维支气管镜在重症社区获得性肺炎局部治疗中的回顾性分析. 临床肺科杂志, 2017, 22(4): 759-760.
2.	靳淑雁, 李双飞, 郑静, 等. 深圳市成人住院社区获得性肺炎流行病学特征分析. 预防医学情报杂志, 2017, 33(7): 693-698.
3.	徐佳兴, 淋浴能, 吴上志. 支气管镜检查在儿童大叶性肺炎的临床应用. 国际呼吸杂志, 2017, 37(3): 189-193.
4.	祖育娜, 张志玲, 张华. 早期电子支气管镜检查在诊治无反应肺炎中的价值. 实用医学杂志, 2017, 33(5): 809-812.
5.	中华医学会. 成人社区获得性肺炎基层诊疗指南 (2018 年). 中华全科医师杂志, 2019, 18(2): 117-126.
6.	朱迎钢, 瞿介明. 临床路径在社区获得性肺炎中的应用. 中国呼吸与危重监护杂志, 2010, 9(1): 97-99.
7.	葛均波, 徐永健, 王辰. 内科学. 第 9 版. 北京: 人民卫生出版社, 2018.
8.	于琳, 王曦雯. 支气管肺泡灌洗治疗社区获得性肺炎的疗效. 疾病监测与控制, 2017, 11(4): 266-267.
9.	Choi MJ, Song JY, Noh JY, et al. Disease burden of hospitalized community-acquired pneumonia in South Korea: analysis based on age and underlying medical conditions. Medicine, 2017, 96(44): e8429.
10.	Kwon JH, Kim JH, Lee JY, et al. Low utility of blood culture in pediatric community-acquired pneumonia: an observational study on 2705 patients admitted to the emergency department. Medicine, 2017, 96(22): e7028.
11.	胡小芳, 李言, 张永. 糖皮质激素辅助治疗社区获得性肺炎研究进展. 中华医院感染学杂志, 2017, 27(2): 477-480.
12.	鞠学贵, 黄贵, 熊波, 等. 首剂抗生素给药时间对成人社区获得性肺炎早期临床疗效影响分析. 实用医院临床杂志, 2017, 14(4): 102-104.
13.	中国卫生和健康委员会社区获得性肺炎临床路径 (2016)[S]. 国家卫生计生委办公厅关于实施有关病种临床路径的通知. 国卫办医函〔2016〕1315 号.
14.	李健球, 熊旭明, 陈望, 等. 支气管肺泡灌洗液可溶性髓样细胞触发受体 1 对创伤后急性呼吸窘迫综合征患者肺部感染的早期诊断价值. 中国呼吸与危重监护杂志, 2014, 13(3): 241-245.
15.	刘志光, 吴怀球, 张卫东, 等. 经支气管镜大容量灌洗治疗支气管扩张症并感染患者的前瞻性研究. 中国呼吸与危重监护杂志, 2014, 13(6): 574-578.
16.	Dell'Orto V, Bourgeois-Nicolaos N, Rouard C, et al. Cell count analysis from nonbronchoscopic bronchoalveolar lavage in preterm infants. J Pediatrics, 2018, 200: 30-37.
17.	刘静华. 动态血清降钙素、CRP 与重症社区获得性肺炎发生、发展及预后的关系. 中国实验诊断学, 2014, 18(2): 213-216.
18.	徐冲, 董丽霞, 曹洁, 等. 降钙素原在社区获得性肺炎预后评估中的价值. 中国呼吸与危重监护杂志, 2017, 16(2): 117-121.
19.	Walsh TL, DiSilvio BE, Hammer C, et al. Impact of procalcitonin guidance with an educational program on management of adults hospitalized with pneumonia. Am J Med, 2017, 131(2): 201.
20.	刘欣欣, 王宁, 张曼林, 等. 经纤维支气管镜诊断曲霉感染 100 例分析. 中国呼吸与危重监护杂志, 2016, 15(1): 78-79.
21.	李红霞, 张晋, 刘冬, 等. 社区获得性肺炎两种治疗方案的药物经济学评价. 中国医药导报, 2016, 13(19): 31-34.

1. 邹立群, 徐爱晖. 纤维支气管镜在重症社区获得性肺炎局部治疗中的回顾性分析. 临床肺科杂志, 2017, 22(4): 759-760.
2. 靳淑雁, 李双飞, 郑静, 等. 深圳市成人住院社区获得性肺炎流行病学特征分析. 预防医学情报杂志, 2017, 33(7): 693-698.
3. 徐佳兴, 淋浴能, 吴上志. 支气管镜检查在儿童大叶性肺炎的临床应用. 国际呼吸杂志, 2017, 37(3): 189-193.
4. 祖育娜, 张志玲, 张华. 早期电子支气管镜检查在诊治无反应肺炎中的价值. 实用医学杂志, 2017, 33(5): 809-812.
5. 中华医学会. 成人社区获得性肺炎基层诊疗指南 (2018 年). 中华全科医师杂志, 2019, 18(2): 117-126.
6. 朱迎钢, 瞿介明. 临床路径在社区获得性肺炎中的应用. 中国呼吸与危重监护杂志, 2010, 9(1): 97-99.
7. 葛均波, 徐永健, 王辰. 内科学. 第 9 版. 北京: 人民卫生出版社, 2018.
8. 于琳, 王曦雯. 支气管肺泡灌洗治疗社区获得性肺炎的疗效. 疾病监测与控制, 2017, 11(4): 266-267.
9. Choi MJ, Song JY, Noh JY, et al. Disease burden of hospitalized community-acquired pneumonia in South Korea: analysis based on age and underlying medical conditions. Medicine, 2017, 96(44): e8429.
10. Kwon JH, Kim JH, Lee JY, et al. Low utility of blood culture in pediatric community-acquired pneumonia: an observational study on 2705 patients admitted to the emergency department. Medicine, 2017, 96(22): e7028.
11. 胡小芳, 李言, 张永. 糖皮质激素辅助治疗社区获得性肺炎研究进展. 中华医院感染学杂志, 2017, 27(2): 477-480.
12. 鞠学贵, 黄贵, 熊波, 等. 首剂抗生素给药时间对成人社区获得性肺炎早期临床疗效影响分析. 实用医院临床杂志, 2017, 14(4): 102-104.
13. 中国卫生和健康委员会社区获得性肺炎临床路径 (2016)[S]. 国家卫生计生委办公厅关于实施有关病种临床路径的通知. 国卫办医函〔2016〕1315 号.
14. 李健球, 熊旭明, 陈望, 等. 支气管肺泡灌洗液可溶性髓样细胞触发受体 1 对创伤后急性呼吸窘迫综合征患者肺部感染的早期诊断价值. 中国呼吸与危重监护杂志, 2014, 13(3): 241-245.
15. 刘志光, 吴怀球, 张卫东, 等. 经支气管镜大容量灌洗治疗支气管扩张症并感染患者的前瞻性研究. 中国呼吸与危重监护杂志, 2014, 13(6): 574-578.
16. Dell'Orto V, Bourgeois-Nicolaos N, Rouard C, et al. Cell count analysis from nonbronchoscopic bronchoalveolar lavage in preterm infants. J Pediatrics, 2018, 200: 30-37.
17. 刘静华. 动态血清降钙素、CRP 与重症社区获得性肺炎发生、发展及预后的关系. 中国实验诊断学, 2014, 18(2): 213-216.
18. 徐冲, 董丽霞, 曹洁, 等. 降钙素原在社区获得性肺炎预后评估中的价值. 中国呼吸与危重监护杂志, 2017, 16(2): 117-121.
19. Walsh TL, DiSilvio BE, Hammer C, et al. Impact of procalcitonin guidance with an educational program on management of adults hospitalized with pneumonia. Am J Med, 2017, 131(2): 201.
20. 刘欣欣, 王宁, 张曼林, 等. 经纤维支气管镜诊断曲霉感染 100 例分析. 中国呼吸与危重监护杂志, 2016, 15(1): 78-79.
21. 李红霞, 张晋, 刘冬, 等. 社区获得性肺炎两种治疗方案的药物经济学评价. 中国医药导报, 2016, 13(19): 31-34.

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Comparison of efficacy and disease burden of tracheoscopy intervention in the initial treatment stage of community-acquired pneumonia in four hospitals

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