La Force F M
Am J Med. 1985 Jun 28;78(6B):52-7. doi: 10.1016/0002-9343(85)90364-x.
The treatment of patients with community-acquired pneumonia can be expensive, particularly if care is hospital-based. Cost control begins with prevention. Current influenza vaccines are about 80 percent protective, but grossly underused. Amantadine and rimantadine are effective chemoprophylactic agents against influenza A, but also underused. Use of pneumococcal vaccine is controversial, but patients who are thought to be at increased risk should be immunized. Management decisions in patients with pneumonia that have major cost implications include the need for hospitalization and choice of diagnostic tests and therapy. The need for hospitalization has not been well studied. In general, young patients with atypical pneumonia are treated at home, whereas older patients with complicating illnesses are admitted to hospitals. Length of hospitalization has decreased in recent years. Diagnostic tests have traditionally emphasized chest roentgenography, Gram staining of the sputum, and sputum culture. Published data suggest that a Gram staining of the sputum can be useful. Sputum cultures are frequently confusing and should be discontinued. Intermittent positive pressure breathing treatments have no value, and chest physiotherapy is unnecessary for most patients.
社区获得性肺炎患者的治疗费用可能很高，尤其是在以医院为基础的治疗情况下。成本控制始于预防。目前的流感疫苗约有80%的保护作用，但使用严重不足。金刚烷胺和金刚乙胺是预防甲型流感的有效化学预防药物，但同样使用不足。肺炎球菌疫苗的使用存在争议，但被认为风险增加的患者应接种疫苗。对肺炎患者做出的具有重大成本影响的管理决策包括住院需求以及诊断测试和治疗的选择。住院需求尚未得到充分研究。一般来说，非典型肺炎的年轻患者在家中接受治疗，而患有并发症的老年患者则住院治疗。近年来住院时间有所缩短。传统上，诊断测试强调胸部X线检查、痰液革兰氏染色和痰培养。已发表的数据表明，痰液革兰氏染色可能有用。痰培养结果常常令人困惑，应该停止。间歇性正压呼吸治疗没有价值，大多数患者也不需要胸部物理治疗。
