Thoraxzentrum Ruhrgebiet, Kliniken für Pneumologie und Infektiologie, Evangelisches Krankenhaus Herne und Augusta-Kranken-Anstalt Bochum, Bergstrasse 26, 44791 Bochum, Germany.
Eur Respir J. 2011 Aug;38(2):253-60. doi: 10.1183/09031936.00199810. Epub 2011 Feb 24.
Community-acquired pneumonia (CAP) is one of the major contemporary acute life-threatening conditions. Short-term mortality reaches 14% (7% if nursing-home residents and bedridden patients are excluded) and long-term mortality reaches 50% within 5 yrs. CAP and acute myocardial infarction (AMI) have a lot in common with regard to acuity, prognosis, need for risk stratification and early intervention, and secondary prevention measures. The obvious success in the treatment of AMI is due to an effective organisation of pre-hospital care and evidence-based interventions in the hospital within defined timescales. Less evidence is available about effective strategies to lower short- and long-term mortality in patients with CAP. Nevertheless, it is estimated that ∼ 30% of hospitalised patients with CAP could be subject to a management approach in parallel to that of acute coronary syndrome (ACS). Management of patients with severe CAP should be intensified using all elements that have been established in the care for patients with ACS and stroke. One of the main challenges of future research will be to define whether and which additional patients at risk of mortality truly profit from timely and structured interventions. In the meantime, patients at increased risk of death according to clinical prediction tools should also be subject to an aggressive management approach.
社区获得性肺炎（CAP）是当代主要的急性危及生命的疾病之一。短期死亡率达到 14%（如果排除疗养院居民和卧床不起的患者则为 7%），5 年内长期死亡率达到 50%。CAP 和急性心肌梗死（AMI）在发病急缓、预后、需要风险分层和早期干预以及二级预防措施方面有很多共同点。AMI 治疗的显著成功归因于有效的院前护理组织和在规定时间范围内在医院内进行基于证据的干预。关于降低 CAP 患者短期和长期死亡率的有效策略的证据较少。然而，据估计，约 30%的住院 CAP 患者可以采用与急性冠状动脉综合征（ACS）相似的管理方法。应使用已在 ACS 和中风患者护理中确立的所有要素来加强对重症 CAP 患者的管理。未来研究的主要挑战之一将是确定是否以及哪些有死亡风险的额外患者真正受益于及时和结构化的干预。同时，根据临床预测工具判断为死亡风险增加的患者也应采用积极的管理方法。
