ذات الرئة المكتسبة في المجتمع في مشفى الأسد الجامعي في اللاذقية التشخيص- تقييم الشدة- العلاج بالصادات
Abstract
أجريت الدراسة على 80 مريضاً متوسط أعمارهم 51.8 سنة( 49 مريضاً- 31 مريضة ) ممن راجعوا مشفى الأسد الجامعي في الفترة بين 22-1-2006 و 22-1- 2007 بقصة ذات رئة مكتسبة في المجتمع، تم قبولهم إما في الجناح العادي(76مريضاً ) أو قسم العناية المشددة(4 مرضى)، وضع قرار القبول للمرضى اعتماداً على القصة المرضية والأعراض السريرية وصورة الصدر الشعاعية، تم بعد ذلك تأكيد التشخيص من خلال الاستقصاءات الضرورية، كما حددت شدة المرض لكل مريض اعتماداً على مشعر تقييم شدة ذات الرئة، أما تحديد العامل الممرض المسبب فقد تم من خلال إجراء زرع دم وزرع قشع. وتمت متابعة المرضى في أثناء العلاج في المشفى ( تحسن - تأخر الاستجابة - ظهور اختلاطات ).
تبين بنتيجة الدراسة:
- الحالات المرضية ذات مشعر PSI) )الأعلى كانت ذات مدة استشفاء أطول وإنذار أسوأ.h
- تحسن معظم المرضى وفق العلاج البدئي ( سفالوسبورين جيل ثالث بالطريق الوريدي مع ماكروليد فمويا ) قبل صدور نتائج الزرع، علما أن هذه النتائج نادرا ماتدخلت في سير العلاج.
- معظم المسببات التي تم كشفها من خلال هذه الزروع المكورات الرئوية،العنقوديات، وقد تمّ عزلها في31.25%من المرضى.
We studied 80 patients whose mean age is 51.8 year (49 males and 31females) who had been admitted to Assad University Hospital between 22-1-2006 and 22-1-2007 with community acquired pneumonia.
Four patients were admitted to intensive care unit while others were in the usual wing. The decision of admission primarily depended on the complaint, symptoms, signs, and chest x ray. Then diagnosis was confirmed by necessary investigations. The severity of disease was detected by pneumonia severity index (PSI).
We tried to define the pathogenic factor by septum and blood cultures. The outcome of primary treatment was judged by assessment of clinical finding (improvement- delay of responding- complications).
The results were:
- When PSI was high the period of hospitalization was longer and the prognosis was worse.
-Most patients improved before detecting the pathogen, and we seldom changed the antibiotic after results of cultures.
- Streptopneumococci and staphylococci were the most defined pathogens, and were isolated in 31.25% of patients.
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