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[致命性重症社区获得性肺炎:医院患者的危险因素、临床特征及医疗差错]

[Fatal severe community-acquired pneumonia: risk factors, clinical characteristics and medical errors of hospital patients].

作者信息

Postnikova L B, Klimkin P F, Boldina M V, Gudim A L, Kubysheva N I

机构信息

Privolzhsky Research Medical University.

City Clinical Hospital №38.

出版信息

Ter Arkh. 2020 Apr 27;92(3):42-49. doi: 10.26442/00403660.2020.03.000538.

DOI:10.26442/00403660.2020.03.000538
PMID:32598792
Abstract

UNLABELLED

Community-acquired pneumonia (CAP) is the most common disease and potentially life-threatening infection in the worldwide. In the Nizhny Novgorod region, no analysis of the causes of mortality and medical errors of severe CAP patients.

AIM

To analyze the patients structure who died severe CAP in hospitals of the Nizhny Novgorod region, to identify the leading risk factors, to assess the clinical characteristics of fatal severe CAP and medical errors according to medical records of patients from 20152016.

MATERIALS AND METHODS

This was a retrospective study of medical records of 139 patients with fatal severe CAP from medical organizations of the Nizhny Novgorod region. The 72 patients died in 2015. The mortality rate from pneumonia was 67 cases in 2016.

RESULTS

The key predictors of the fatal severe CAP in patients of the Nizhny Novgorod region identified: socio-demographic status (men of working age, unemployed, smoking, alcohol and drug dependence), late treatment and hospitalization, tachypnea, hypotension, tachycardia, confusion, leukocytosis or leukopenia, thrombocytopenia, anemia, hyperglycemia, bilateral lung damage, pleural effusion, acute respiratory failure. The leading medical errors in fatal CAP were incorrect assessment of the severity of the patients condition, untimely CAP, non-monitoring of SpO2 on the first day of hospitalization, late transfer of patients to the intensive care unit, there was no influenza therapy, inadequate starting antibacterial therapy.

CONCLUSION

The main ways to avoid or minimize medical errors and reduce the mortality of patients with TVP is strict adherence to clinical recommendations, active preventive measures, diagnosis and treatment of chronic diseases.

摘要

未标注

社区获得性肺炎(CAP)是全球最常见且可能危及生命的感染性疾病。在下诺夫哥罗德地区,尚未对重症CAP患者的死亡原因和医疗差错进行分析。

目的

根据2015 - 2016年患者的病历,分析下诺夫哥罗德地区医院中死于重症CAP的患者结构,确定主要危险因素,评估致命性重症CAP的临床特征和医疗差错。

材料与方法

这是一项对下诺夫哥罗德地区医疗机构139例致命性重症CAP患者病历的回顾性研究。2015年有72例患者死亡。2016年肺炎死亡率为67例。

结果

确定了下诺夫哥罗德地区患者致命性重症CAP的关键预测因素:社会人口统计学状况(工作年龄男性、失业、吸烟、酒精和药物依赖)、治疗和住院延迟、呼吸急促、低血压、心动过速、意识障碍、白细胞增多或白细胞减少、血小板减少、贫血、高血糖、双侧肺损伤、胸腔积液、急性呼吸衰竭。致命性CAP的主要医疗差错包括对患者病情严重程度评估错误、CAP治疗不及时、住院首日未监测SpO₂、患者转入重症监护病房延迟、未进行流感治疗、起始抗菌治疗不足。

结论

避免或最小化医疗差错以及降低TVP患者死亡率的主要方法是严格遵循临床建议、采取积极预防措施、诊断和治疗慢性疾病。

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