重症肺炎7.13.ppt

* * * * * * * 目前关于肺部感染的评分模式研究比较多，最为公认的，且为指南所推荐的有PSI与CURB-65两种，具有较好的评估效果。 Clin Infect Dis.?2007 Mar 1;44 Suppl 2:S27-72. Infectious?Diseases?Society?of?America/American?Thoracic?Society?consensus?guidelines?on the?management?ofcommunity-acquired?pneumonia?in?aduLts. Mandell LA1,?Wunderink RG,?Anzueto A,?Bartlett JG,?Campbell GD,?Dean NC,?Dowell SF,?File TM Jr,?Musher DM,?Niederman MS,?Torres A,?Whitney CG;Infectious?Diseases?Society?of?America;?American?Thoracic?Society. Severity-of-illness scores, such as the CURB-65 criteria (confusion, uremia, respiratory rate, low blood pressure, age 65 years or greater), or prognostic models, such as the Pneumonia Severity Index (PSI), can be used to identify patients with CAP who may be candidates for out-patient treatment. (Strong recommendation; level I evidence.) Intern Med.?2006;45(7):419-28. Epub 2006 May 1. The?JRS?guidelines?for the?management?of?community-acquired?pneumonia?in?aduLts: an?update?and?newrecommendations. Miyashita N1,?Matsushima T,?Oka M,?Japanese Respiratory Society. Physicians often use models of prognosis to quantify the severity of illness and guide the initial site of treatment decision for patients with CAP. The Pneumonia Severity Index (PSI) is based on the findings of the Pneumonia Patient Outcomes Research Team (PORT) cohort study by Fine et al (34). They stratified patients into five risk classes according to 20 clinical and laboratory variables, and found a clear correlation between mortality and risk class. The PSI appears to be an excellent predictor of mortality in patients with CAP. Utilization of the PSI for initial risk assessment has been widely endorsed by organizations such as the IDSA and others (12-14). Subsequently, Lim et al modified the CURB score and derived from it a new severity assessment tool, the“CURB-65 score”, which includes age ≧65 years as a fifth prognostic variable based on the largest cohort study (40). The advantage of the CURB-65 score is that it provi