{"id":50699,"date":"2025-04-25T05:11:12","date_gmt":"2025-04-25T05:11:12","guid":{"rendered":"http:\/\/zydq.1006ss.com\/?p=50699"},"modified":"2025-04-25T05:11:12","modified_gmt":"2025-04-25T05:11:12","slug":"%e6%80%a5%e8%af%8a%e6%88%90%e4%ba%ba%e7%a4%be%e5%8c%ba%e8%8e%b7%e5%be%97%e6%80%a7%e8%82%ba%e7%82%8e%e4%b8%b4%e5%ba%8a%e5%ae%9e%e8%b7%b5%e6%8c%87%e5%8d%97%ef%bc%88-2024-%e5%b9%b4%e7%89%88","status":"publish","type":"post","link":"http:\/\/zydq.1006ss.com\/?p=50699","title":{"rendered":"\u6025\u8bca\u6210\u4eba\u793e\u533a\u83b7\u5f97\u6027\u80ba\u708e\u4e34\u5e8a\u5b9e\u8df5\u6307\u5357\uff08 2024 \u5e74\u7248\uff09"},"content":{"rendered":"

\u793e\u533a\u83b7\u5f97\u6027\u80ba\u708e\uff08 community acquired pneumonia, CAP\uff09\u662f\u6700\u5e38\u89c1\u7684\u611f\u67d3\u6027\u75be\u75c5\u4e4b\u4e00\u3002\u8c03\u67e5\u663e\u793a\uff0c\u5927\u90e8\u5206 CAP \u60a3\u8005\u5728\u6025\u8bca\u8fdb\u884c\u521d\u59cb\u8bca\u65ad\u548c\u6cbb\u7597\u3002\u7136\u800c\uff0c\u5404\u7ea7\u533b\u9662\u6025\u8bca\u5bf9\u4e8eCAP \u7684\u8bca\u6cbb\u80fd\u529b\u5dee\u5f02\u8f83\u5927\uff0c\u4ece\u800c\u5bfc\u81f4\u6cbb\u7597\u6548\u679c\u5b58\u5728\u8f83\u5927\u5dee\u522b\u3002 2015 \u5e74\u4e2d\u56fd\u533b\u5e08\u534f\u4f1a\u6025\u8bca\u533b\u5e08\u5206\u4f1a\u7275\u5934\u5236\u8ba2\u4e86\u300a\u4e2d\u56fd\u6025\u8bca\u793e\u533a\u83b7\u5f97\u6027\u80ba\u708e\u4e34\u5e8a\u5b9e\u8df5\u6307\u5357\u300b\uff0c\u5bf9\u5404\u7ea7\u533b\u9662\u6025\u8bca CAP\u7684\u8bca\u6cbb\u8d77\u5230\u4e86\u8f83\u597d\u7684\u6307\u5bfc\u4f5c\u7528\u3002\u8fd1\u5e74\u6765\uff0c\u56fd\u5185\u5916\u5728 CAP \u8bca\u65ad\u3001\u6cbb\u7597\u7b49\u65b9\u9762\u5747\u6709\u4e00\u5b9a\u7684\u8fdb\u5c55\uff0c\u4e3a\u66f4\u597d\u5730\u6307\u5bfc\u5404\u5730\u6025\u8bca CAP\u7684\u8bca\u6cbb\uff0c\u672c\u6307\u5357\u7f16\u5199\u7ec4\u5728\u5145\u5206\u9075\u5faa\u300a\u4e2d\u56fd\u5236\u8ba2 \/ \u4fee\u8ba2\u4e34\u5e8a\u8bca\u7597\u6307\u5357\u7684\u6307\u5bfc\u539f\u5219\uff082022 \u7248\uff09\u300b\u7684\u57fa\u7840\u4e0a\uff0c\u5bf9 2015 \u5e74\u6307\u5357\u8fdb\u884c\u66f4\u65b0\u548c\u4fee\u8ba2\uff0c\u5f62\u6210\u65b0\u7248\u6025\u8bca\u6210\u4eba CAP \u4e34\u5e8a\u5b9e\u8df5\u6307\u5357\u3002\u672c\u6307\u5357\u9002\u7528\u4e8e\u5e74\u9f84 18 \u5468\u5c81\u53ca\u4ee5\u4e0a CAP \u60a3\u8005\uff0c\u4e0d\u5305\u62ec 2019\u51a0\u72b6\u75c5\u6bd2\u75c5\uff08COVID-19\uff09\u76f8\u5173\u80ba\u708e\u53ca\u514d\u75ab\u6291\u5236\u4eba\u7fa4\u7f79\u60a3\u7684\u80ba\u708e\u3002 <\/p>\n

1 \u6210\u4eba CAP \u5b9a\u4e49<\/p>\n

CAP \u662f\u6307\u5728\u533b\u9662\u5916\u7f79\u60a3\u7684\u611f\u67d3\u6027\u80ba\u5b9e\u8d28\u708e\u75c7\uff0c\u5305\u62ec\u5177\u6709\u660e\u786e\u6f5c\u4f0f\u671f\u7684\u75c5\u539f\u4f53\u611f\u67d3\u5728\u5165\u9662\u540e\u6f5c\u4f0f\u671f\u5185\u53d1\u75c5\u7684\u80ba\u708e\u3002<\/p>\n

2 \u6d41\u884c\u75c5\u5b66\u7279\u70b9<\/b><\/b><\/p>\n

2016 \u5e74\u6211\u56fd 23 \u4e2a\u7701\u4efd\u8986\u76d6\u603b\u4eba\u53e3 4.2752 \u4ebf\u57ce\u9547\u4eba\u53e3\u4e2d\uff0c CAP \u53d1\u751f\u7387\u7ea6\u4e3a 7.13\/(1000 \u4eba \u00b7 \u5e74 )\uff0c\u7537\u6027\u7684\u53d1\u75c5\u7387\u7565\u9ad8\u4e8e\u5973\u6027\u3002 CAP \u53d1\u75c5\u7387\u968f\u5e74\u9f84\u53d8\u5316\u5448 U \u5f62\u66f2\u7ebf\uff0c\u5728<5 \u5c81\u7684\u513f\u7ae5\u548c\u226580 \u5c81\u7684\u8001\u5e74\u4eba\u7fa4 [14.98\/(1000 \u4eba \u00b7 \u5e74 )] \u4e2d\u8fbe\u5230\u5cf0\u503c\uff0c\u4e14\u5b58\u5728\u660e\u663e\u7684\u5730\u533a\u5dee\u5f02\u548c\u5b63\u8282\u8d8b\u52bf\uff0c\u51ac\u6625\u5b63\u4e3a\u9ad8\u53d1\u5b63\u8282\u3002\u4e00\u9879\u9488\u5bf9\u6211\u56fd\u4e0d\u540c\u5730\u533a 4 \u7701\u5e02\u7684\u524d\u77bb\u6027\u7814\u7a76\u53d1\u73b0\uff0c 2016- 2019 \u5e74\u4f4f\u9662 CAP \u60a3\u8005\u7684\u5e74\u5e73\u5747\u53d1\u75c5\u7387\u7ea6\u4e3a 187\/10 \u4e07\u3002\u91cd\u75c7 CAP \u7ea6\u5360\u6211\u56fd CAP \u60a3\u8005\u7684 13.58%~20.05%\uff0c\u5176\u4e2d 60 \u5c81\u4ee5\u4e0a\u4eba\u7fa4\u5360\u91cd\u75c7 CAP \u7684 35.38%\u3002<\/p>\n

\u8fd1\u5e74\u6765\uff0c\u6570\u9879\u7814\u7a76\u663e\u793a\u6211\u56fdCAP \u9662\u5185\u75c5\u6b7b\u7387\u57280.8% ~ 2.1%\uff0c \u91cd \u75c7 CAP \u9662 \u5185 \u75c5 \u6b7b \u7387 \u9ad8\u4e8e 2.49%\u3002 \u6211 \u56fdCAP \u60a3\u8005\u5e74\u9f84\u6807\u51c6\u5316\u75c5\u6b7b\u7387\u5448\u9010\u6e10\u4e0b\u964d\u8d8b\u52bf\uff0c 2013 \u5e74\u30012019 \u5e74\u548c 2021 \u5e74\u5206\u522b\u4e3a 11.18\/10 \u4e07\u30018.76\/10 \u4e07\u53ca 5.74\/10 \u4e07\uff0c\u5176\u4e2d\u7537\u6027\u5e74\u9f84\u6807\u51c6\u5316\u75c5\u6b7b\u7387\u9ad8\u4e8e\u5973\u6027\u3002 CAP \u60a3\u8005\u7684\u75c5\u6b7b\u7387\u968f\u5e74\u9f84\u589e\u52a0\u800c\u5347\u9ad8\uff0c 65 \u5c81\u4ee5\u4e0a CAP \u60a3\u8005\u4f4f\u9662\u75c5\u6b7b\u7387\u53ef\u8fbe5.7%\uff0c\u8001\u5e74\u91cd\u75c7 CAP \u60a3\u8005\u75c5\u6b7b\u7387\u9ad8\u8fbe 22.27%\u3002 2013 \u5e74\u6211\u56fd 65 \u5c81\u4ee5\u4e0a CAP \u60a3\u8005\u75c5\u6b7b\u7387\u4e3a 99.48\/10 \u4e07\uff0c 2021 \u5e74\u663e\u8457\u4e0b\u964d\u81f3 56.15\/10 \u4e07\u3002<\/p>\n

3 \u75c5\u539f\u5b66\u7279\u70b9<\/b><\/b><\/p>\n

\u8fd1\u5e74\u6765\uff0c\u968f\u7740\u5206\u5b50\u751f\u7269\u5b66\u68c0\u6d4b\u6280\u672f\u7684\u53d1\u5c55\u4e0e\u666e\u53ca\uff0c\u4e00\u5b9a\u7a0b\u5ea6\u4e0a\u66f4\u65b0\u4e86\u4e34\u5e8a\u5bf9 CAP \u75c5\u539f\u5b66\u7684\u8ba4\u8bc6\u3002\u6211\u56fd\u4e00\u9879\u4e3a\u671f12 \u5e74\u3001\u8986\u76d6 30 \u4e2a\u7701\u3001\u6d89\u53ca\u5168\u5e74\u9f84\u6bb5 CAP \u60a3\u8005\u7684\u7814\u7a76\u663e\u793a\uff1a\u75c5\u6bd2\u68c0\u51fa\u7387\u4e3a 36.64%\uff0c\u6700\u9ad8\u7684\u662f\u6d41\u611f\u75c5\u6bd2\uff0810.74%\uff09\uff0c\u5176\u6b21\u662f\u547c\u5438\u9053\u5408\u80de\u75c5\u6bd2\uff0810.5%\uff09\u548c\u9f3b\u75c5\u6bd2\uff086.78%\uff09\uff1b\u7ec6\u83cc\u7684\u68c0\u51fa\u7387\u4e3a 27.08%\uff0c\u80ba\u708e\u94fe\u7403\u83cc\u68c0\u51fa\u7387\u6700\u9ad8\uff087.49%\uff09\uff0c\u5176\u4f59\u4f9d\u6b21\u4e3a\u80ba\u708e\u514b\u96f7\u4f2f\u83cc\uff086.95%\uff09\u3001\u94dc\u7eff\u5047\u5355\u80de\u83cc\uff085.81%\uff09\u3001\u80ba\u708e\u652f\u539f\u4f53\uff084.79%\uff09\u3001\u6d41\u611f\u55dc\u8840\u6746\u83cc\uff083.36%\uff09\u548c\u91d1\u9ec4\u8272\u8461\u8404\u7403\u83cc\uff083.26%\uff09\u3002 22.47% \u7684\u60a3\u8005\u4e3a\u6df7\u5408\u611f\u67d3\uff0c11.04% \u4e3a\u75c5\u6bd2\u548c\u7ec6\u83cc\u6df7\u5408\u611f\u67d3\uff0c 7.43% \u4e3a\u75c5\u6bd2\u548c\u75c5\u6bd2\u6df7\u5408\u611f\u67d3\uff0c 3.63% \u4e3a\u7ec6\u83cc\u548c\u7ec6\u83cc\u6df7\u5408\u611f\u67d3\u3002<\/p>\n

\u6d41\u611f\u75c5\u6bd2\u662f CAP \u4e2d\u6700\u5e38\u68c0\u6d4b\u5230\u7684\u75c5\u6bd2\uff0c\u4e5f\u662f\u91cd\u75c7 CAP\u5e38\u89c1\u75c5\u539f\u4f53\u3002\u6d41\u611f\u75c5\u6bd2\u611f\u67d3\u540e\u6613\u7ee7\u53d1\u7ec6\u83cc\u611f\u67d3\uff0c\u5982\u91d1\u9ec4\u8272\u8461\u8404\u7403\u83cc\u3001\u80ba\u708e\u94fe\u7403\u83cc\u548c\u6d41\u611f\u55dc\u8840\u6746\u83cc\u7b49\u3002\u9f3b\u75c5\u6bd2\u3001\u526f\u6d41\u611f\u75c5\u6bd2\u3001\u504f\u80ba\u75c5\u6bd2\u3001\u547c\u5438\u9053\u5408\u80de\u75c5\u6bd2\u53ca\u817a\u75c5\u6bd2\u7b49\u547c\u5438\u9053\u75c5\u6bd2\u5728 CAP \u4e2d\u4e5f\u8f83\u5e38\u89c1\u3002\u6d41\u611f\u75c5\u6bd2\u80ba\u708e\u901a\u5e38\u89c1\u4e8e 45\u5c81\u4ee5\u4e0a\u7684\u60a3\u8005\uff0c\u800c\u817a\u75c5\u6bd2\u80ba\u708e\u5e38\u89c1\u4e8e\u9752\u58ee\u5e74\u3002\u6211\u56fd\u4e00\u9879\u7814\u7a76\u8868\u660e\u5728 11.0% \u7684\u75c5\u6bd2\u6027 CAP \u4e2d\u5206\u79bb\u51fa\u66f2\u9709\uff0c\u5408\u5e76\u66f2\u9709\u611f\u67d3\u60a3\u8005\u75c5\u6b7b\u7387\u663e\u8457\u5347\u9ad8\u3002<\/p>\n

\u8fd1\u6765\u56fd\u5185\u62a5\u9053\u80ba\u708e\u94fe\u7403\u83cc\u548c\u80ba\u708e\u652f\u539f\u4f53\u5360\u6210\u4eba CAP \u75c5\u539f\u4f53\u6bd4\u4f8b\u8f83\u524d\u671f\u56fd\u5185\u7814\u7a76\u6709\u6240\u4e0b\u964d\uff0c\u4f46\u4e24\u8005\u5728 CAP \u4e2d\u4ecd\u5177\u6709\u91cd\u8981\u5730\u4f4d\u3002\u80ba\u708e\u94fe\u7403\u83cc\u662f\u6210\u4eba\u91cd\u75c7 CAP \u5e38\u89c1\u7684\u75c5\u539f\u4f53\u4e4b\u4e00\uff0c\u800c\u80ba\u708e\u652f\u539f\u4f53\u5728\u5e74\u8f7b\u53ca\u95e8\u8bca\u60a3\u8005\u4e2d\u8f83\u4e3a\u5e38\u89c1\u3002\u5bf9\u4e8e\u8001\u5e74\u6216\u5b58\u5728\u57fa\u7840\u75be\u75c5\u7684 CAP \u60a3\u8005\uff08\u5982\u5fc3\u8111\u8840\u7ba1\u75be\u75c5\u3001\u80be\u529f\u80fd\u8870\u7aed\u3001\u7cd6\u5c3f\u75c5\u7b49\uff09\uff0c\u867d\u7136\u80ba\u708e\u94fe\u7403\u83cc\u548c\u6d41\u611f\u75c5\u6bd2\u4ecd\u662f\u4e3b\u8981\u81f4\u75c5\u539f\uff0c\u4f46\u80ba\u708e\u514b\u96f7\u4f2f\u83cc\u3001\u94dc\u7eff\u5047\u5355\u80de\u83cc\u3001\u6d41\u611f\u55dc\u8840\u6746\u83cc\u7b49\u9769\u5170\u9634\u6027\u6746\u83cc\u6240\u5360\u6bd4\u4f8b\u663e\u8457\u63d0\u5347\u3002\u8001\u5e74 CAP \u5c24\u5176\u662f\u91cd\u75c7\u60a3\u8005\u5e38\u5b58\u5728\u591a\u79cd\u75c5\u539f\u4f53\u6df7\u5408\u611f\u67d3\uff0c\u4ee5\u9769\u5170\u9634\u6027\u6746\u83cc\u3001\u80ba\u708e\u94fe\u7403\u83cc\u53ca\u547c\u5438\u9053\u75c5\u6bd2\u6700\u4e3a\u5e38\u89c1\u3002\u5bf9\u4e8e\u5408\u5e76\u6162\u6027\u963b\u585e\u6027\u80ba\u75c5\u3001\u652f\u6c14\u7ba1\u6269\u5f20\u7b49\u7ed3\u6784\u6027\u80ba\u75c5\u7684\u60a3\u8005\uff0c\u5e94\u6ce8\u610f\u94dc\u7eff\u5047\u5355\u80de\u83cc\u611f\u67d3\u7684\u98ce\u9669\u3002<\/p>\n

\u5728\u75c5\u539f\u4f53\u8010\u836f\u65b9\u9762\uff0c\u6211\u56fd\u975e\u8111\u819c\u708e\u80ba\u708e\u94fe\u7403\u83cc\u5bf9\u5927\u73af\u5185\u916f\u7c7b\u836f\u7269\u7684\u8010\u836f\u7387\u8fbe 90% \u4ee5\u4e0a\uff0c\u5bf9\u9759\u8109\u9752\u9709\u7d20\u3001\u4e09\u4ee3\u5934\u5b62\u83cc\u7d20\u53ca\u55b9\u8bfa\u916e\u7c7b\u836f\u7269\u4fdd\u6301\u8f83\u597d\u7684\u654f\u611f\u6027 \u3002\u80ba\u708e\u652f\u539f\u4f53\u5bf9\u5927\u73af\u5185\u916f\u7c7b\u836f\u7269\u7684\u8010\u836f\u7387\u4ea6\u5728 80% \u4ee5\u4e0a\uff0c\u5bf9\u55b9\u8bfa\u916e\u53ca\u56db\u73af\u7d20\u7c7b\u836f\u7269\u5177\u6709\u826f\u597d\u7684\u654f\u611f\u6027\u3002\u6d41\u611f\u55dc\u8840\u6746\u83cc\uff08\u6210\u4eba\u682a\uff09\u5bf9\u6c28\u82c4\u897f\u6797\/\u963f\u83ab\u897f\u6797\u3001\u590d\u65b9\u78fa\u80fa\u7532\u5641\u5511\u548c\u5927\u73af\u5185\u916f\u7c7b\u7684\u8010\u836f\u7387\u8f83\u9ad8\uff0c\u5bf9\u9752\u9709\u7d20\/\u03b2-\u5185\u9170\u80fa\u9176\u6291\u5236\u5242\u590d\u5408\u7269\u3001\u7b2c\u4e09\u4ee3\/\u56db\u4ee3\u5934\u5b62\u83cc\u7d20\u3001\u55b9\u8bfa\u916e\u7c7b\u548c\u56db\u73af\u7d20\u7c7b\u836f\u7269\u4ecd\u9ad8\u5ea6\u654f\u611f\u3002<\/p>\n

\u63a8\u8350\u610f\u89c1 1\uff1a<\/b>\u547c\u5438\u9053\u76f8\u5173\u75c5\u6bd2\u3001\u80ba\u708e\u94fe\u7403\u83cc\u3001\u80ba\u708e\u652f\u539f\u4f53\u53ca\u80ba\u708e\u514b\u96f7\u4f2f\u6746\u83cc\u7b49\u662f\u6211\u56fd\u6210\u4eba <\/b>CAP <\/b>\u5e38\u89c1\u75c5\u539f\u4f53\uff0c\u6df7\u5408\u611f\u67d3\u5360\u6709\u4e00\u5b9a\u6bd4\u4f8b\u3002\u8001\u5e74 <\/b>CAP <\/b>\u4e2d\u80ba\u708e\u514b\u96f7\u4f2f\u83cc\u53ca\u94dc\u7eff\u5047\u5355\u80de\u83cc\u7b49\u9769\u5170\u9634\u6027\u6746\u83cc\u5360\u6bd4\u589e\u52a0\u3002\u80ba\u708e\u94fe\u7403\u83cc\u53ca\u80ba\u708e\u652f\u539f\u4f53\u5bf9\u5927\u73af\u5185\u916f\u7c7b\u836f\u7269\u7684\u8010\u836f\u7387\u9ad8\uff08\u8bc1\u636e\u7b49\u7ea7\u2161\uff0c\u63a8\u8350\u7b49\u7ea7 <\/b>A<\/b>\uff09\u3002<\/b><\/b><\/p>\n

4 \u6210\u4eba CAP \u8bca\u65ad\u6807\u51c6\u4e0e\u5206\u8bca\u539f\u5219<\/b><\/b><\/p>\n

4.1 \u8bca\u65ad\u6807\u51c6<\/p>\n

\u5728\u793e\u533a\u53d1\u75c5\uff0c\u51fa\u73b0\u80f8\u90e8\u5f71\u50cf\u5b66\u6539\u53d8\uff0c\u5e76\u6ee1\u8db3\u4e0b\u8ff0 4 \u9879\u80ba\u708e\u76f8\u5173\u4e34\u5e8a\u8868\u73b0\u4efb\u610f 1 \u9879\uff0c\u4e14\u9664\u5916\u80ba\u7ed3\u6838\u3001\u80ba\u90e8\u80bf\u7624\u3001\u975e\u611f\u67d3\u6027\u80ba\u75be\u75c5\u3001\u80ba\u6c34\u80bf\u3001\u80ba\u4e0d\u5f20\u3001\u80ba\u6813\u585e\u3001\u80ba\u55dc\u9178\u7c92\u7ec6\u80de\u6d78\u6da6\u75c7\u53ca\u80ba\u8840\u7ba1\u708e\u7b49\u5176\u4ed6\u75be\u75c5\uff0c\u53ef\u4ee5\u4e34\u5e8a\u8bca\u65ad CAP\u3002<\/p>\n

\u80f8\u90e8\u5f71\u50cf\u5b66\u6539\u53d8\u4e3a\u65b0\u51fa\u73b0\u7684\u6591\u7247\u72b6\u6d78\u6da6\u5f71\u3001\u53f6\u6216\u6bb5\u5b9e\u53d8\u5f71\u3001\u78e8\u73bb\u7483\u5f71\u6216\u95f4\u8d28\u6027\u6539\u53d8\uff0c\u4f34\u6216\u4e0d\u4f34\u6709\u80f8\u8154\u79ef\u6db2\u3002<\/p>\n

\u4e34\u5e8a\u8868\u73b0 \uff1a\uff081\uff09\u65b0\u8fd1\u51fa\u73b0\u7684\u54b3\u55fd\u3001\u54b3\u75f0\u6216\u8005\u539f\u6709\u547c\u5438\u9053\u75be\u75c5\u75c7\u72b6\u52a0\u91cd\uff0c\u4f34\u6216\u4e0d\u4f34\u8113\u75f0\u3001\u80f8\u75db\u3001\u547c\u5438\u56f0\u96be\u53ca\u54af\u8840\u3002\uff082\uff09\u53d1\u70ed\u3002\uff083\uff09\u80ba\u5b9e\u53d8\u4f53\u5f81\u548c\uff08\u6216\uff09\u95fb\u53ca\u6e7f\u5570\u97f3\u3002\uff084\uff09\u5916\u5468\u8840\u767d\u7ec6\u80de >10\u00d7109<\/sup>\/L \u6216 <4\u00d7109<\/sup>\/L\uff0c\u4f34\u6216\u4e0d\u4f34\u7ec6\u80de\u6838\u5de6\u79fb\u3002<\/p>\n

4.2 \u5206\u8bca\u539f\u5219<\/p>\n

\u6025\u8bca\u9884\u68c0\u5206\u8bca\u662f\u6025\u8bca\u60a3\u8005\u5c31\u8bca\u7684\u9996\u8981\u73af\u8282\uff0c\u51c6\u786e\u9ad8\u6548\u7684\u9884\u68c0\u5206\u8bca\u80fd\u65e9\u671f\u8bc6\u522b\u7591\u4f3c CAP \u60a3\u8005\uff0c\u5e76\u6839\u636e\u75c5\u60c5\u5206\u7ea7\u53ca\u65f6\u5904\u7406\u3002\u56fd\u5bb6\u65e9\u671f\u9884\u8b66\u8bc4\u5206\uff08national early warning score, NEWS\uff09\u662f\u8bc4\u4f30\u6025\u8bca CAP \u60a3\u8005\u75c5\u60c5\u7684\u8bc4\u5206\u5de5\u5177\u4e4b\u4e00\uff08\u88682\uff09\uff0c NEWS \u8bc4\u5206\u5347\u9ad8\u4e0e\u75c5\u60c5\u4e25\u91cd\u6027\u53ca\u5165\u4f4f\u91cd\u75c7\u76d1\u62a4\u75c5\u623f\uff08 intensive care unit, ICU\uff09\u98ce\u9669\u76f8\u5173\uff08\u8868 3\uff09\u3002<\/p>\n

\u60a3\u8005\u81f3\u6025\u8bca\u5206\u8bca\u53f0\u540e\uff0c\u5206\u8bca\u62a4\u58eb\u5e94\u5feb\u901f\u8bc4\u4f30\u3002\u82e5\u60a3\u8005\u6709\u53d1\u70ed\u3001\u54b3\u55fd\u3001\u54b3\u75f0\u6216\u539f\u6709\u547c\u5438\u9053\u75be\u75c5\u75c7\u72b6\u52a0\u91cd\uff0c\u53ef\u7591\u8bca\u4e3a CAP\u3002\u7ed3\u5408\u60a3\u8005\u7684\u6d41\u884c\u75c5\u5b66\u53f2\uff0c\u82e5\u8003\u8651\u4f20\u67d3\u6027 CAP \u5219\u6309\u4f20\u67d3\u75c5\u9632\u6cbb\u6cd5\u5904\u7f6e\uff1b\u5bf9\u4e8e\u975e\u4f20\u67d3\u6027 CAP\uff0c\u901a\u8fc7 NEWS \u8bc4\u5206\u8fdb\u884c\u5371\u9669\u5206\u5c42\u5e76\u51b3\u5b9a\u8bca\u7597\u5730\u70b9\uff08\u56fe 1\uff09\u3002<\/p>\n

\u63a8\u8350\u610f\u89c1 2\uff1a<\/b> \u5bf9\u7591\u8bca <\/b>CAP <\/b>\u7684\u6025\u8bca\u60a3\u8005\u63a8\u8350\u4f7f\u7528 <\/b>NEWS<\/b>\u8bc4\u5206\u6309\u6d41\u7a0b\u8fdb\u884c\u9884\u68c0\u5206\u8bca\uff0c\u4ee5\u51b3\u5b9a\u60a3\u8005\u7684\u5c31\u8bca\u573a\u6240\uff08\u8bc1\u636e\u7b49\u7ea7\u2161\uff0c\u63a8\u8350\u7b49\u7ea7 <\/b>B<\/b>\uff09\u3002<\/b><\/b><\/p>\n

5 \u6210\u4eba CAP \u8bca\u65ad\u601d\u8def<\/b><\/b><\/p>\n

5.1 \u521d\u6b65\u8bca\u65ad<\/p>\n

\u591a\u6570 CAP \u60a3\u8005\u6709\u53d1\u70ed\u3001\u54b3\u55fd\u3001\u54b3\u75f0\u6216\u6c14\u4fc3\u7b49\u5178\u578b\u8868\u73b0\u3002\u67d0\u4e9b\u75c5\u539f\u4f53\uff08\u5982\u55dc\u80ba\u519b\u56e2\u83cc\u7b49\uff09\u6216\u91cd\u75c7 CAP \u60a3\u8005\u4e0d\u4ec5\u51fa\u73b0\u547c\u5438\u9053\u75c7\u72b6\uff0c\u8fd8\u53ef\u6709\u5168\u8eab\u75c7\u72b6\u53ca\u591a\u810f\u5668\u53d7\u7d2f\u3002\u8001\u5e74 CAP \u60a3\u8005\u53ef\u65e0\u53d1\u70ed\u54b3\u55fd\u7b49\u5178\u578b\u75c7\u72b6\uff0c\u800c\u8868\u73b0\u4e3a\u610f\u8bc6\u6539\u53d8\u3001\u4e4f\u529b\u3001\u5c3f\u5931\u7981\u3001\u6d3b\u52a8\u80fd\u529b\u51cf\u9000\u3001\u98df\u6b32\u4e0b\u964d\u7b49\uff0c\u6216\u4ec5\u51fa\u73b0\u547c\u5438\u9891\u7387\u589e\u5feb\u7b49\u4e0d\u5178\u578b\u75c7\u72b6\u3002\u8840\u767d\u7ec6\u80de\u3001 C \u53cd\u5e94\u86cb\u767d\uff08 C-reactive protein, CRP\uff09\u3001\u964d\u9499\u7d20\u539f\uff08 procalcitonin, PCT\uff09\u53ca\u767d\u4ecb\u7d206\u7b49\u662f\u534f\u52a9\u8bca\u65ad CAP \u7684\u5e38\u7528\u5b9e\u9a8c\u5ba4\u6307\u6807\u3002CRP \u53ef\u4f5c\u4e3a CAP\u8bca\u65ad\u9996\u9009\u708e\u6027\u6807\u5fd7\u7269\uff1b\u7ec6\u83cc\u6027\u80ba\u708e PCT \u6c34\u5e73\u5e38\u5347\u9ad8\uff0c\u4ee50.25 \u03bc g\/L \u4f5c\u4e3a\u8bca\u65ad\u9608\u503c\u9274\u522b\u7ec6\u83cc\u548c\u975e\u7ec6\u83cc\u611f\u67d3\u7684\u9634\u6027\u9884\u6d4b\u503c\u4e3a 92.4%\u3002\u767d\u4ecb\u7d20 6 \u7b49\u5728\u5224\u65ad\u75c5\u60c5\u4ee5\u53ca\u9884\u540e\u5177\u6709\u4e00\u5b9a\u7684\u4ef7\u503c\u3002\u80f8\u90e8 X \u7ebf\u662f\u8bca\u65ad CAP \u7684\u5e38\u7528\u5f71\u50cf\u5b66\u65b9\u6cd5\uff0c\u4f46\u5176\u5b58\u5728\u8bca\u65ad\u5ef6\u8fdf\u6216\u6f0f\u8bca\u7684\u98ce\u9669\u3002\u7591\u8bca CAP \u800c\u80f8\u90e8 X \u7ebf\u6b63\u5e38\u8005\uff0c\u5e94\u8fdb\u884c\u80f8\u90e8 CT \u626b\u63cf\u3002\u5927\u53f6\u6027\u80ba\u708e\u3001\u5c0f\u53f6\u6027\u80ba\u708e\u53ca\u95f4\u8d28\u6027\u80ba\u708e\u662f CAP \u5e38\u89c1\u7684\u5f71\u50cf\u8868\u73b0\uff0c\u5178\u578b\u5f71\u50cf\u5b66\u8868\u73b0\uff08\u88684\uff09\u6709\u52a9\u4e8e CAP \u7684\u8bca\u65ad\u3002<\/p>\n

5.2 \u9274\u522b\u8bca\u65ad<\/p>\n

\u9700\u8981\u5728\u6392\u9664\u80ba\u7ed3\u6838\u3001\u80ba\u764c\u3001\u7ed3\u7f14\u7ec4\u7ec7\u75be\u75c5\u3001\u95f4\u8d28\u6027\u80ba\u75c5\u3001\u8840\u7ba1\u708e\u3001\u80ba\u6c34\u80bf\u3001\u80ba\u6813\u585e\u3001\u8fc7\u654f\u6027\u80ba\u708e\u7b49\u75be\u75c5\u540e\u65b9\u80fd\u8bca\u65adCAP\uff08\u9644\u5f55\u88681\uff09\u3002\u6025\u8bca\u533b\u5e08\u5728\u521d\u6b65\u8bca\u65ad CAP \u7684\u540c\u65f6\uff0c\u5e94\u914c\u60c5\u5b89\u6392\u76f8\u5e94\u68c0\u9a8c\u548c\u68c0\u67e5\u4e0e\u4e0a\u8ff0\u75be\u75c5\u76f8\u9274\u522b\u3002<\/p>\n

5.3 CAP \u4e25\u91cd\u7a0b\u5ea6\u8bc4\u4f30\u53ca\u5206\u533a\u5904\u7f6e<\/p>\n

CAP \u75c5\u60c5\u4e25\u91cd\u7a0b\u5ea6\u8bc4\u4f30\u65b9\u6cd5\u5e38\u7528\u7684\u6709 CRB-65 \u8bc4\u5206\u3001CURB-65 \u8bc4\u5206\u3001\u80ba\u708e\u4e25\u91cd\u6307\u6570\uff08pneumonia severity index, PSI\uff09\u8bc4\u5206\u3001 APACHE \u2161\u8bc4\u5206\u53ca SMATR-COP \u8bc4\u5206\u7b49\u3002\u5176\u4e2d SMART-COP \u8bc4\u5206\u76f8\u5bf9\u590d\u6742\uff0c\u4e0d\u9002\u4e8e\u95e8\u6025\u8bca\u5feb\u901f\u5e94\u7528\uff0c\u4f46\u5728\u9884\u6d4b CAP \u60a3\u8005\u662f\u5426\u9700\u8981\u5165\u4f4f ICU \u7684\u6548\u80fd\u4f18\u4e8e CURB- 65 \u53ca PSI \u8bc4\u5206\u3002CRB-65\/CURB-65 \u8bc4\u5206\u7cfb\u7edf\u7b80\u4fbf\u6613\u884c\uff0c\u66f4\u9002\u7528\u4e8e\u6025\u8bca\u5feb\u901f\u8bc4\u4f30\u3002\uff08\u8868 5\uff09<\/p>\n

CURB-65 \u548c PSI \u8bc4\u5206\u4e3b\u8981\u7528\u4e8e\u8bc4\u4f30 30 d \u75c5\u6b7b\u7387\uff0c\u5e76\u4e0d\u4e00\u5b9a\u80fd\u591f\u51c6\u786e\u53cd\u6620 CAP \u4e25\u91cd\u7a0b\u5ea6\uff0c\u53ef\u6309\u8868 6 \u52a8\u6001\u8bc4\u4f30 CAP\u60a3\u8005\u75c5\u60c5\uff0c\u4e00\u65e6\u8fbe\u5230\u91cd\u75c7 CAP \u6807\u51c6\uff0c\u9700\u53ca\u65f6\u8f6c\u81f3\u6709\u6761\u4ef6\u7684\u5355\u5143\uff08\u5982\u6025\u8bca ICU\uff09\u8bca\u6cbb\u3002 <\/p>\n

\u63a8\u8350\u610f\u89c1 3\uff1a \u8bca\u65ad <\/b>CAP <\/b>\u65f6\u5e94\u8fdb\u884c\u76f8\u5173\u9274\u522b\u8bca\u65ad\uff0c\u90e8\u5206<\/b>CAP <\/b>\u60a3\u8005\u4e34\u5e8a\u8868\u73b0\u4e0d\u5178\u578b\uff0c\u8c28\u9632\u6f0f\u8bca\u3002\u5e94\u5feb\u901f\u8bc4\u4f30\u60a3\u8005\u75c5\u60c5\u4e25\u91cd\u7a0b\u5ea6\uff0c\u5e76\u8fdb\u884c\u5408\u7406\u5206\u533a\u5904\u7f6e\u3002<\/b>CRB-65\/CURB-65 <\/b>\u8bc4\u5206\u7cfb\u7edf\u7b80\u4fbf\u6613\u884c\uff0c\u9002\u7528\u4e8e\u6025\u8bca\u5feb\u901f\u8bc4\u4f30\uff08\u8bc1\u636e\u7b49\u7ea7\u2161\uff0c\u63a8\u8350\u7b49\u7ea7 <\/b>B<\/b>\uff09\u3002<\/b><\/b><\/p>\n

5.4 \u63a8\u6d4b\u53ef\u80fd\u7684\u75c5\u539f\u4f53\u53ca\u8010\u836f\u98ce\u9669<\/p>\n

5.4.1 CAP \u75c5\u539f\u4f53\u63a8\u6d4b\u539f\u5219<\/p>\n

\u51c6\u786e\u63a8\u6d4b CAP \u75c5\u539f\u4f53\u5e76\u4e88\u4ee5\u6070\u5f53\u7684\u7ecf\u9a8c\u6027\u6cbb\u7597\u81f3\u5173\u91cd\u8981\uff0c\u53ef\u4ee5\u7f29\u77ed\u4f4f\u9662\u65f6\u95f4\u3001\u6539\u5584\u60a3\u8005\u9884\u540e\u3002\u5e94\u6839\u636e\u60a3\u8005\u7684\u5e74\u9f84\u3001\u57fa\u7840\u75c5\u548c\u5371\u9669\u56e0\u7d20\u3001\u53d1\u75c5\u5b63\u8282\u3001\u6d41\u884c\u75c5\u5b66\u4fe1\u606f\u3001\u75c5\u60c5\u4e25\u91cd\u7a0b\u5ea6\u3001\u75c7\u72b6\u4f53\u5f81\u3001\u80f8\u90e8\u5f71\u50cf\u5b66\u53ca\u5b9e\u9a8c\u5ba4\u68c0\u67e5\u7b49\u7efc\u5408\u63a8\u6d4b CAP \u53ef\u80fd\u7684\u75c5\u539f\u4f53\u53ca\u8010\u836f\u98ce\u9669\u3002<\/p>\n

\u5e94\u8be6\u7ec6\u8be2\u95ee\u76f8\u5173\u75c5\u53f2\uff0c\u5982\u57fa\u7840\u75be\u75c5\u53f2\u3001\u8fd1\u671f\u65c5\u884c\u53f2\u3001\u4f20\u67d3\u6027\u75be\u75c5\u60a3\u8005\uff08\u5982\u7ed3\u6838\u3001\u6d41\u611f\u3001\u9ebb\u75b9\u7b49\uff09\u63a5\u89e6\u53f2\u3001\u79bd\u7c7b\u63a5\u89e6\u53f2\u3001\u6613\u6ecb\u751f\u9709\u83cc\u6216\u55dc\u80ba\u519b\u56e2\u83cc\u7684\u73af\u5883\u66b4\u9732\u53f2\u3001\u9157\u9152\u6216\u836f\u7269\u6ee5\u7528\u53f2\u3001\u8bef\u5438\u9ad8\u98ce\u9669\uff08\u5982\u541e\u54bd\u969c\u788d\uff09\u7b49\u60c5\u51b5\uff0c\u4ee5\u63a8\u6d4b\u53ef\u80fd\u611f\u67d3\u7684\u75c5\u539f\u83cc\uff08\u8868 7\uff09\u3002\u5178\u578b\u5f71\u50cf\u5b66\u8868\u73b0\u5bf9\u63a8\u6d4b CAP \u75c5\u539f\u4f53\u6709\u4e00\u5b9a\u5e2e\u52a9\uff0c\u4e0d\u540c\u75c5\u539f\u83cc\u6240\u81f4 CAP \u7684\u5f71\u50cf\u5b66\u4e0a\u6709\u4e9b\u5177\u6709\u7279\u5f81\u6027\u8868\u73b0\uff08\u8868 4\uff09\u3002\u7136\u800c\uff0c\u7531\u4e8e\u60a3\u8005\u57fa\u7840\u72b6\u6001\u3001\u75c5\u7a0b\u53ca\u6df7\u5408\u611f\u67d3\u7b49\u56e0\u7d20\u5e72\u6270\uff0c\u4ec5\u6839\u636e\u5f71\u50cf\u5b66\u6709\u65f6\u96be\u4ee5\u51c6\u786e\u63a8\u6d4b\u75c5\u539f\u4f53\uff0c\u4e34\u5e8a\u9700\u8981\u7ed3\u5408\u60a3\u8005\u4e34\u5e8a\u7279\u5f81\u3001\u5b9e\u9a8c\u5ba4\u68c0\u67e5\u53ca\u7ec6\u83cc\u5b66\u68c0\u67e5\u7b49\u8fdb\u884c\u7efc\u5408\u5206\u6790\u3002<\/p>\n

5.4.2 \u8010\u836f\u98ce\u9669\u8bc4\u4f30<\/p>\n

CAP \u75c5\u539f\u83cc\u7684\u6784\u6210\u548c\u8010\u836f\u6027\uff0c\u4e0e\u5730\u57df\u3001\u4eba\u7fa4\u53ca\u5730\u533a\u7528\u836f\u4e60\u60ef\u7b49\u6709\u8f83\u5927\u5173\u7cfb\uff0c\u9700\u5145\u5206\u8ba4\u8bc6\u672c\u5730\u533a\u7684\u6d41\u884c\u75c5\u5b66\u53ca\u8010\u836f\u8c31\u3002\u5df2\u77e5\u611f\u67d3\u8010\u836f\u75c5\u539f\u4f53\u7684\u5371\u9669\u56e0\u7d20\u5305\u62ec\uff1a\u9ad8\u9f84\u3001\u514d\u75ab\u6291\u5236\u3001\u4fb5\u88ad\u6027\u64cd\u4f5c\u3001\u53cd\u590d\u4f4f\u9662\u53f2\u3001\u8010\u836f\u83cc\u5b9a\u690d\u3001\u8fd1\u671f\u5e94\u7528\u5e7f\u8c31\u6297\u83cc\u836f\u7b49\uff0c\u4e0d\u5b58\u5728\u4e0a\u8ff0\u5371\u9669\u56e0\u7d20\u7684\u60a3\u8005\u8010\u836f\u83cc\u611f\u67d3\u53ef\u80fd\u6027\u8f83\u4f4e\uff08\u8868 8\uff09\u3002<\/p>\n

\u63a8\u8350\u610f\u89c1 4\uff1a<\/b> \u6839\u636e\u60a3\u8005\u7684\u5e74\u9f84\u3001\u57fa\u7840\u75c5\u53ca\u76f8\u5173\u5371\u9669\u56e0\u7d20\u3001\u53d1\u75c5\u5b63\u8282\u3001\u6d41\u884c\u75c5\u5b66\u7279\u70b9\u3001\u75c5\u60c5\u4e25\u91cd\u7a0b\u5ea6\u3001\u4e34\u5e8a\u7279\u70b9\u3001\u80f8\u90e8\u5f71\u50cf\u5b66\u53ca\u5b9e\u9a8c\u5ba4\u68c0\u67e5\u7b49\u6765\u7efc\u5408\u63a8\u6d4b <\/b>CAP <\/b>\u53ef\u80fd\u7684\u75c5\u539f\u4f53\u53ca\u5176\u8010\u836f\u98ce\u9669\uff08\u8bc1\u636e\u7b49\u7ea7\u2162\uff0c\u63a8\u8350\u7b49\u7ea7 <\/b>B<\/b>\uff09\u3002<\/b><\/p>\n

5.5 \u5408\u7406\u8fdb\u884c\u75c5\u539f\u5b66\u68c0\u67e5<\/p>\n

\uff081\uff09\u7531\u4e8e\u7ecf\u9a8c\u6027\u6297\u751f\u7d20\u6cbb\u7597\u591a\u6570\u80fd\u53d6\u5f97\u6210\u529f\uff0c\u6545\u4e0d\u63a8\u8350\u5bf9\u4e8e\u6025\u8bca\u95e8\u8bca\u6cbb\u7597\u7684\u8f7b\u75c7 CAP \u60a3\u8005\u5e38\u89c4\u8fdb\u884c\u75c5\u539f\u5b66\u68c0\u67e5\u3002\u4f46\u805a\u96c6\u6027\u75c5\u4f8b\u3001\u521d\u59cb\u6cbb\u7597\u6548\u679c\u4e0d\u4f73\u53ca\u8003\u8651\u6d41\u611f\u75c5\u6bd2\u7b49\u611f\u67d3\uff08\u68c0\u6d4b\u7ed3\u679c\u4f1a\u5f71\u54cd\u6cbb\u7597\u65b9\u6848\u9009\u62e9\uff09\u7684\u95e8\u8bca\u60a3\u8005\u5efa\u8bae\u8fdb\u884c\u75c5\u539f\u5b66\u7b5b\u67e5\u3002<\/p>\n

\uff082\uff09\u5bf9\u4e8e\u4f4f\u9662\u6216\u6025\u8bca\u7559\u89c2\u60a3\u8005\uff0c\u660e\u786e\u81f4\u75c5\u75c5\u539f\u4f53\u6709\u52a9\u4e8e\u9488\u5bf9\u6027\u5236\u5b9a\u6cbb\u7597\u65b9\u6848\u3001\u4f18\u5316\u6297\u83cc\u836f\u7269\u7ba1\u7406\u3001\u5c3d\u65e9\u53d1\u73b0\u5e94\u62a5\u544a\u7684\u7279\u6b8a\u75c5\u539f\u4f53\u3002\u53ef\u6839\u636e\u60a3\u8005\u75c5\u60c5\u548c\u53ef\u53ca\u7684\u533b\u7597\u8d44\u6e90\uff0c\u9488\u5bf9\u6027\u9009\u62e9\u75c5\u539f\u5b66\u68c0\u67e5\u9879\u76ee\uff08\u4e0d\u540c\u4e34\u5e8a\u7279\u70b9 CAP \u63a8\u8350\u75c5\u539f\u5b66\u68c0\u67e5\u89c1\u8868 9\uff09\u3002<\/p>\n

\u75f0\u6807\u672c\u662f\u6700\u5e38\u7528\u7684 CAP \u75c5\u539f\u5b66\u68c0\u67e5\u6807\u672c\u3002\u5408\u683c\u7684\u75f0\u6807\u672c\u5e94\u662f\u60a3\u8005\u6df1\u547c\u5438\u540e\uff0c\u7531\u80ba\u90e8\u6df1\u5904\u54b3\u51fa\u7684\u5206\u6ccc\u7269\uff0c\u6807\u672c\u91cf\u5e94\u5728 1 mL \u4ee5\u4e0a\uff0c\u5176\u4e2d\u9cde\u72b6\u4e0a\u76ae\u7ec6\u80de <10 \u4e2a \/ \u4f4e\u500d\u89c6\u91ce\uff0c\u591a\u6838\u767d\u7ec6\u80de >25 \u4e2a \/ \u4f4e\u500d\u89c6\u91ce\uff0c\u6216\u4e8c\u8005\u6bd4\u4f8b <1 \u2236 2.5\u3002\u82e5\u75f0\u6807\u672c\u4e2d\u9cde\u72b6\u4e0a\u76ae\u7ec6\u80de\u5927\u4e8e 10 \u4e2a \/ \u4f4e\u500d\u89c6\u91ce\uff0c\u5219\u53ef\u80fd\u5b58\u5728\u53e3\u54bd\u90e8\u7684\u7ec6\u83cc\u6c61\u67d3\uff0c\u4e0d\u5b9c\u505a\u75f0\u57f9\u517b\u3002\u75f0\u6807\u672c\u5e94\u8be5 2 h \u5185\u9001\u5230\u5b9e\u9a8c\u5ba4\u5904\u7406\u3002<\/p>\n

\u63a8\u8350\u610f\u89c1 5 \uff1a<\/b> \u4e0d\u63a8\u8350\u5bf9\u4e8e\u6025\u8bca\u95e8\u8bca\u6cbb\u7597\u7684\u8f7b\u75c7 <\/b>CAP <\/b>\u60a3\u8005\u5e38\u89c4\u8fdb\u884c\u75c5\u539f\u5b66\u68c0\u67e5\u3002\u4f46\u805a\u96c6\u6027\u75c5\u4f8b\u3001\u521d\u59cb\u6cbb\u7597\u6548\u679c\u4e0d\u4f73\u53ca\u8003\u8651\u6d41\u611f\u75c5\u6bd2\u611f\u67d3\u7684\u95e8\u8bca\u60a3\u8005\u5efa\u8bae\u8fdb\u884c\u75c5\u539f\u5b66\u7b5b\u67e5\u3002\uff08\u8bc1\u636e\u7b49\u7ea7\u2162\uff0c\u63a8\u8350\u7b49\u7ea7 <\/b>B<\/b>\uff09\u3002\u4f4f\u9662\u6216\u6025\u8bca\u7559\u89c2\u60a3\u8005\uff0c\u53ef\u6709\u9488\u5bf9\u6027\u9009\u62e9\u75c5\u539f\u5b66\u68c0\u67e5\u9879\u76ee\uff08\u8bc1\u636e\u7b49\u7ea7 <\/b>I<\/b>\uff0c\u63a8\u8350\u7b49\u7ea7 <\/b>A<\/b>\uff09\u3002<\/b><\/b><\/p>\n

\uff083\uff09\u6709\u4e0b\u5217\u60c5\u51b5\u8005\uff0c\u53ef\u914c\u60c5\u8003\u8651\u4fb5\u5165\u6027\u8bca\u65ad\u6280\u672f \uff1a\u2460\u63a5\u53d7\u673a\u68b0\u901a\u6c14\u6cbb\u7597\u7684\u91cd\u75c7 CAP \u60a3\u8005 \uff1b\u2461 \u5bf9\u4e8e\u521d\u59cb\u7ecf\u9a8c\u6027\u6cbb\u7597\u5931\u8d25\uff0c\u6000\u7591\u7279\u6b8a\u75c5\u539f\u4f53\u611f\u67d3\uff0c\u7279\u522b\u662f\u514d\u75ab\u529f\u80fd\u53d7\u635f\u60a3\u8005\u6709\u673a\u4f1a\u6027\u81f4\u75c5\u539f\u611f\u67d3\u9ad8\u98ce\u9669\uff0c\u5e38\u89c4\u65b9\u6cd5\u83b7\u53d6\u7684\u547c\u5438\u9053\u6807\u672c\u4e0d\u80fd\u8bca\u65ad\u65f6 \uff1b\u2462\u6cbb\u7597\u6548\u679c\u4e0d\u4f73\uff0c\u9700\u8981\u4e0e\u975e\u611f\u67d3\u6027\u80ba\u90e8\u75be\u75c5\u9274\u522b\u8bca\u65ad\u8005\u3002\u4e0a\u8ff0\u4e09\u79cd\u60c5\u51b5\u53ef\u83b7\u53d6\u6c14\u7ba1\u5185\u5438\u51fa\u7269\u3001\u652f\u6c14\u7ba1\u80ba\u6ce1\u704c\u6d17\u6db2\u3001\u9632\u6c61\u67d3\u6bdb\u5237\uff0c\u751a\u81f3\u5185\u955c\u4e0b\u6216\u7ecf\u76ae\u80ba\u7ec4\u7ec7\u6d3b\u68c0\u3002\u2463\u80ba\u708e\u5408\u5e76\u540c\u4fa7\u80f8\u8154\u79ef\u6db2\u4e0d\u80fd\u660e\u786e\u75c5\u56e0\u8005\uff0c\u53ef\u62bd\u53d6\u80f8\u8154\u79ef\u6db2\u8fdb\u884c\u75c5\u539f\u5b66\u68c0\u67e5\u3002<\/p>\n

\uff084\uff09\u4f4f\u9662\u7684 CAP \u60a3\u8005\uff0c\u6709\u4e0b\u5217\u56e0\u7d20\u4e4b\u4e00\u7684\uff0c\u53ef\u8003\u8651\u91c7\u96c6\u652f\u6c14\u7ba1\u80ba\u6ce1\u704c\u6d17\u6db2\u3001\u4e0b\u547c\u5438\u9053\u5206\u6ccc\u7269\u3001\u75f0\u6db2\u6216\u8840\u6db2\u8fdb\u884c\u75c5\u539f\u5fae\u751f\u7269\u57fa\u56e0\u9ad8\u901a\u91cf\u6d4b\u5e8f\uff08 NGS\uff09\u3002\u2460\u75be\u75c5\u521d\u671f\u5373\u91cd\u75c7\u5316\uff0c\u9700\u8981\u751f\u547d\u652f\u6301\u6216\u7ecf\u89c4\u8303\u6027\u6297\u611f\u67d3\u6cbb\u7597 48~72 h \u540e\uff0c\u611f\u67d3\u4ecd\u6301\u7eed\u52a0\u91cd\u6216\u5f71\u50cf\u5b66\u5feb\u901f\u8fdb\u5c55\u8005\uff1b\u2461\u8003\u8651\u7279\u6b8a\u81f4\u75c5\u539f\u5e38\u89c4\u68c0\u6d4b\u96be\u4ee5\u68c0\u51fa\u8005\uff08\u5982\u55dc\u80ba\u519b\u56e2\u83cc\u3001\u9e66\u9e49\u70ed\u8863\u539f\u4f53\u3001\u94a9\u7aef\u87ba\u65cb\u4f53\u7b49\uff09\uff1b\u2462\u7591\u4f3c\u4f20\u67d3\u75c5\u805a\u96c6\u6027\u53d1\u75c5\uff0c\u65e0\u6cd5\u660e\u786e\u75c5\u539f\u4f53\uff1b\u2463\u514d\u75ab\u6291\u5236\u60a3\u8005\u75c5\u60c5\u8fdb\u5c55\uff0c\u5e38\u89c4\u68c0\u67e5\u96be\u4ee5\u660e\u786e\u75c5\u539f\u5fae\u751f\u7269\u8005\uff1b\u2464\u5e38\u89c4\u57f9\u517b\u53ca\u805a\u5408\u9176\u94fe\u5f0f\u53cd\u5e94\uff08PCR\uff09\u7b49\u68c0\u6d4b\u4e0d\u80fd\u786e\u5b9a\u75c5\u539f\u4f53\u4e14\u75c5\u60c5\u52a0\u91cd\u8005\uff1b\u2465\u7ecf\u89c4\u8303\u6297\u611f\u67d3\u6cbb\u7597\uff0c\u75c5\u7076\u5438\u6536\u5ef6\u8fdf\u3001\u9700\u8981\u9274\u522b\u662f\u5426\u7531\u975e\u611f\u67d3\u75be\u75c5\u6240\u81f4\u8005\u3002<\/p>\n

\u63a8\u8350\u610f\u89c1 6 \uff1a <\/b>\u5bf9\u4e8e\u91cd\u75c7 <\/b>CAP <\/b>\u60a3\u8005\u3001\u521d\u59cb\u7ecf\u9a8c\u6027\u6cbb\u7597\u5931\u8d25\u3001\u6000\u7591\u7279\u6b8a\u75c5\u539f\u4f53\u611f\u67d3\u6216\u9700\u8981\u4e0e\u975e\u611f\u67d3\u6027\u80ba\u90e8\u75be\u75c5\u9274\u522b\u8bca\u65ad\u8005\u3001\u514d\u75ab\u529f\u80fd\u53d7\u635f\u6709\u673a\u4f1a\u6027\u81f4\u75c5\u539f\u611f\u67d3\u9ad8\u98ce\u9669\u8005\uff0c\u53ef\u8003\u8651\u4fb5\u5165\u6027\u8bca\u65ad\u6280\u672f\u83b7\u53d6\u6807\u672c\uff08\u6c14\u7ba1\u5185\u5438\u51fa\u7269\u3001\u652f\u6c14\u7ba1\u80ba\u6ce1\u704c\u6d17\u6db2\u3001\u80f8\u8154\u79ef\u6db2\u7b49\uff09\u3002\uff08\u8bc1\u636e\u7b49\u7ea7\u2162\uff0c\u63a8\u8350\u7b49\u7ea7 <\/b>B<\/b>\uff09\u3002\u5b58\u5728\u4e0a\u8ff0\u60c5\u51b5\uff0c\u6216\u7591\u4f3c\u4f20\u67d3\u75c5\u805a\u96c6\u6027\u53d1\u75c5\uff0c\u65e0\u6cd5\u660e\u786e\u75c5\u539f\u4f53\u8005\uff0c\u6216\u5e38\u89c4\u57f9\u517b\u53ca <\/b>PCR <\/b>\u7b49\u68c0\u6d4b\u4ecd\u4e0d\u80fd\u786e\u5b9a\u75c5\u539f\u4f53\u4e14\u75c5\u60c5\u52a0\u91cd\u8005\uff0c\u53ef\u8003\u8651\u8fdb\u884c\u75c5\u539f\u5fae\u751f\u7269\u57fa\u56e0 <\/b>NGS <\/b>\u68c0\u6d4b\uff08\u8bc1\u636e\u7b49\u7ea7\u2162\uff0c\u63a8\u8350\u7b49\u7ea7 <\/b>B<\/b>\uff09\u3002<\/b><\/b><\/p>\n

6 \u6210\u4eba CAP \u7ecf\u9a8c\u6027\u6297\u611f\u67d3\u6cbb\u7597<\/b><\/b><\/p>\n

\u5728\u5236\u5b9a\u7ecf\u9a8c\u6027\u6cbb\u7597\u65b9\u6848\u65f6\uff0c\u9700\u8981\u7efc\u5408\u8003\u8651\u591a\u65b9\u9762\u56e0\u7d20\uff1a\u6700\u53ef\u80fd\u7684\u75c5\u539f\u4f53\u3001\u8010\u836f\u98ce\u9669\u3001\u75be\u75c5\u4e25\u91cd\u7a0b\u5ea6\u3001\u4e2a\u4f53\u56e0\u7d20\uff08\u5982\u5e74\u9f84\u3001\u57fa\u7840\u75be\u75c5\u3001\u6297\u751f\u7d20\u8fc7\u654f\u53f2\u3001\u514d\u75ab\u529f\u80fd\u72b6\u6001\uff09\uff0c\u4ee5\u53ca\u4e0d\u540c\u5730\u533a\u7684\u75c5\u539f\u4f53\u6d41\u884c\u75c5\u5b66\u7279\u5f81\u548c\u8010\u836f\u7387\u3002\u540c\u65f6\u9700\u91cd\u89c6\u836f\u7269\u7684\u836f\u4ee3\u52a8\u529b\u5b66\u548c\u836f\u6548\u5b66\u7279\u6027\uff0c\u4ee5\u8fbe\u5230\u6307\u5bfc\u7528\u836f\u5242\u91cf\u3001\u4f18\u5316\u7ed9\u836f\u65b9\u6848\u3001\u9884\u9632\u8010\u836f\u6027\u53d1\u5c55\u3001\u8bc4\u4f30\u7597\u6548\u4ee5\u53ca\u4e2a\u4f53\u5316\u6cbb\u7597\u7684\u76ee\u7684\uff08\u886810\uff09\u3002<\/p>\n

\u672c\u6307\u5357\u5bf9\u6025\u8bca CAP \u7ecf\u9a8c\u6027\u6297\u611f\u67d3\u6cbb\u7597\u7684\u63a8\u8350\u610f\u89c1\u5982\u4e0b\u3002<\/p>\n

\u63a8\u8350\u610f\u89c1 7 \uff1a <\/b>\u521d\u6b65\u8bca\u65ad\u7ec6\u83cc\u6027 <\/b>CAP <\/b>\u60a3\u8005\uff0c\u4e89\u53d6\u63a5\u8bca\u540e<\/b>4~8 h <\/b>\u5185\u542f\u52a8\u6297\u751f\u7d20\u6cbb\u7597\u3002\u8113\u6bd2\u75c7\u53ca\u8113\u6bd2\u6027\u4f11\u514b\u60a3\u8005\uff0c\u5efa\u8bae<\/b>1 h <\/b>\u4e4b\u5185\u542f\u52a8\u6297\u751f\u7d20\u6cbb\u7597\u3002\u4f46\u6025\u8bca\u8bca\u7597\u5728\u8ffd\u6c42<\/b>‘<\/b>\u5feb\u201d\u7684\u540c\u65f6\uff0c\u4e0d\u80fd\u5ffd\u7565\u5fc5\u8981\u7684\u9274\u522b\u8bca\u65ad\uff08\u8bc1\u636e\u7b49\u7ea7\u2161\uff0c\u63a8\u8350\u7b49\u7ea7 <\/b>B<\/b>\uff09\u3002<\/b><\/b><\/p>\n

\u63a8\u8350\u610f\u89c1 8 \uff1a<\/b> \u5bf9\u4e8e\u6025\u8bca\u8f7b\u75c7 <\/b>CAP <\/b>\u60a3\u8005\uff0c\u63a8\u8350\u9009\u62e9\u5177\u6709\u826f\u597d\u751f\u7269\u5229\u7528\u5ea6\u7684\u6297\u611f\u67d3\u836f\u7269\u5355\u836f\u53e3\u670d\uff0c\u53ef\u9009\u7528\u963f\u83ab\u897f\u6797\u514b\u62c9\u7ef4\u9178\u6216\u4e00\u4ee3\u3001\u4e8c\u4ee3\u5934\u5b62\u83cc\u7d20\uff1b\u5bf9\u4e8e\u5b58\u5728\u8010\u836f\u98ce\u9669\u60a3\u8005\uff0c\u53ef\u9009\u7528\u9752\u9709\u7d20\u7c7b\u9176\u6291\u5236\u5242\u590d\u5408\u7269\u3001\u4e09\u4ee3\u5934\u5b62\u83cc\u7d20\uff0c\u547c\u5438\u55b9\u8bfa\u916e\u7c7b\u6216\u5965\u9a6c\u73af\u7d20\u3002\u8003\u8651\u652f\u539f\u4f53\u3001\u8863\u539f\u4f53\u611f\u67d3\u8005\uff0c\u53ef\u9009\u62e9\u591a\u897f\u73af\u7d20\u3001\u7c73\u8bfa\u73af\u7d20 \uff1b\u5728\u5927\u73af\u5185\u916f\u7c7b\u836f\u7269\u8010\u836f\u7387\u4f4e\u7684\u5730\u533a\uff08<\/b><25%<\/b>\uff09\u53ef\u9009\u62e9\u5927\u73af\u5185\u916f\u7c7b\u836f\u7269 \uff1b\u8010\u836f\u7387\u9ad8\u7684\u5730\u533a\u6216\u5bf9\u4e0a\u8ff0\u836f\u7269\u8fc7\u654f\u6216\u4e0d\u8010\u53d7\u8005\u53ef\u4f7f\u7528\u547c\u5438\u55b9\u8bfa\u916e\u7c7b\uff08\u8bc1\u636e\u7b49\u7ea7\u2161\uff0c\u63a8\u8350\u7b49\u7ea7 <\/b>B<\/b>\uff09\u3002<\/b><\/b><\/p>\n

\u63a8\u8350\u610f\u89c1 9 \uff1a <\/b>\u5bf9\u4e8e\u6025\u8bca\u7559\u89c2 <\/b>\/ <\/b>\u4f4f\u9662 <\/b>CAP <\/b>\u60a3\u8005\uff0c\u63a8\u8350\u5355\u72ec\u4f7f\u7528 \u03b2 <\/b>– <\/b>\u5185\u9170\u80fa\u7c7b\uff0c\u6216\u8054\u5408\u56db\u73af\u7d20\u7c7b <\/b>\/ <\/b>\u5927\u73af\u5185\u916f\u7c7b\uff08\u8010\u836f\u7387\u4f4e\u5730\u533a\uff09\uff0c\u6216\u8005\u5355\u7528\u547c\u5438\u55b9\u8bfa\u916e\u7c7b\u6216\u5965\u9a6c\u73af\u7d20\u3002\u6709\u4ea7<\/b>ESBL <\/b>\u80a0\u6746\u83cc\u79d1\u83cc\u611f\u67d3\u9ad8\u98ce\u9669\u8005\uff0c\u53ef\u9009\u7528\u5934\u9709\u7d20\u7c7b\u3001\u54cc\u62c9\u897f\u6797\u4ed6\u5511\u5df4\u5766\u3001\u5934\u5b62\u54cc\u916e\u8212\u5df4\u5766\u6216\u78b3\u9752\u9709\u70ef\u7c7b\u3002\u5bf9\u4e8e\u4e34\u5e8a\u7591\u4f3c\u80ba\u7ed3\u6838\u7684\u60a3\u8005\uff0c\u7ecf\u9a8c\u6027\u6cbb\u7597\u65f6\u4e0d\u5efa\u8bae\u4f7f\u7528\u5177\u6709\u6297\u7ed3\u6838\u4f5c\u7528\u7684\u55b9\u8bfa\u916e\u7c7b\u836f\u7269\uff08\u8bc1\u636e\u7b49\u7ea7\u2161\uff0c\u63a8\u8350\u7b49\u7ea7 <\/b>B<\/b>\uff09\u3002<\/b><\/b><\/p>\n

\u63a8\u8350\u610f\u89c1 10 \uff1a <\/b>\u5bf9\u4e8e\u6025\u8bca\u91cd\u75c7\u76d1\u62a4 <\/b>CAP <\/b>\u60a3\u8005\uff0c\u63a8\u8350 \u03b2 <\/b>–<\/b>\u5185\u9170\u80fa\u7c7b\u8054\u5408\u5927\u73af\u5185\u916f\u7c7b <\/b>\/ <\/b>\u56db\u73af\u7d20\u7c7b\uff0c\u6216\u8054\u5408\u547c\u5438\u55b9\u8bfa\u916e\u7c7b\u3002\u9700\u8bc4\u4f30\u4ea7 <\/b>ESBL <\/b>\u80a0\u6746\u83cc\u79d1\u7ec6\u83cc\u3001\u94dc\u7eff\u5047\u5355\u80de\u83cc\u53ca<\/b>MRSA <\/b>\u611f\u67d3\u7684\u98ce\u9669\uff08\u8bc1\u636e\u7b49\u7ea7\u2161\uff0c\u63a8\u8350\u7b49\u7ea7 <\/b>B<\/b>\uff09\u3002<\/b><\/b><\/p>\n

\u63a8\u8350\u610f\u89c1 11 \uff1a <\/b>\u5bf9\u4e8e\u6709\u5438\u5165\u6027\u80ba\u708e\u98ce\u9669\u7684\u60a3\u8005\uff0c\u63a8\u8350\u9009\u62e9\u5177\u6709\u6297\u538c\u6c27\u83cc\u6d3b\u6027\u7684\u5e7f\u8c31\u6297\u83cc\u836f\u7269\uff0c\u5982 \u03b2 <\/b>– <\/b>\u5185\u9170\u80fa\u9176\u6291\u5236\u5242\u590d\u5408\u7269\u3001\u83ab\u897f\u6c99\u661f\u3001\u5948\u8bfa\u6c99\u661f\u6216\u78b3\u9752\u9709\u70ef\u7c7b\u7b49\u3002\u9664\u975e\u51fa\u73b0\u80ba\u8113\u80bf\u6216\u8113\u80f8\u7b49\u5e76\u53d1\u75c7\uff0c\u4e14\u4e0a\u8ff0\u836f\u7269\u6cbb\u7597\u6548\u679c\u4e0d\u4f73\u4e4b\u5916\uff0c\u4e00\u822c\u65e0\u9700\u989d\u5916\u8054\u5408\u785d\u57fa\u54aa\u5511\u7c7b\u836f\u7269\uff08\u8bc1\u636e\u7b49\u7ea7\u2161\uff0c\u63a8\u8350\u7b49\u7ea7 <\/b>A<\/b>\uff09\u3002<\/b><\/b><\/p>\n

\u63a8\u8350\u610f\u89c1 12 \uff1a<\/b> \u5728\u6d41\u611f\u6d41\u884c\u5b63\u8282\uff0c\u5bf9\u6000\u7591\u6d41\u611f\u75c5\u6bd2\u611f\u67d3\u7684 <\/b>CAP <\/b>\u60a3\u8005\uff0c\u63a8\u8350\u5e38\u89c4\u8fdb\u884c\u6d41\u611f\u75c5\u6bd2\u6297\u539f\u6216\u6838\u9178\u68c0\u67e5\uff0c\u5e76\u5e94\u5c3d\u65e9\u5e94\u7528\u795e\u7ecf\u6c28\u9178\u9176\u6291\u5236\u5242\uff08\u5965\u53f8\u4ed6\u97e6\u3001\u5e15\u62c9\u7c73\u97e6\u7b49\uff09\u6216 <\/b>RNA <\/b>\u805a\u5408\u9176\u6291\u5236\u5242\uff08\u739b\u5df4\u6d1b\u6c99\u97e6\uff09\u7b49\u6297\u75c5\u6bd2\u6cbb\u7597\u3002\u5373\u4f7f\u53d1\u75c5\u65f6\u95f4\u8d85\u8fc7 <\/b>48 h <\/b>\u4e5f\u63a8\u8350\u5e94\u7528\u6297\u75c5\u6bd2\u836f\u7269\u3002\u9700\u6ce8\u610f\u6d41\u611f\u7ee7\u53d1\u7ec6\u83cc\u6216\u771f\u83cc\u611f\u67d3\u7684\u53ef\u80fd\uff08\u8bc1\u636e\u7b49\u7ea7\u2161\uff0c\u63a8\u8350\u7b49\u7ea7 <\/b>A<\/b>\uff09\u3002<\/b><\/b><\/p>\n

\u63a8\u8350\u610f\u89c1 13 \uff1a <\/b>\u5bf9\u4e8e\u598a\u5a20\u671f <\/b>CAP <\/b>\u60a3\u8005\uff0c\u4f18\u5148\u9009\u62e9\u598a\u5a20\u98ce\u9669\u7b49\u7ea7\u8f83\u4f4e\u7684\u6297\u83cc\u836f\u7269\uff0c\u5982\u9752\u9709\u7d20\u7c7b\u548c\u5934\u5b62\u83cc\u7d20\u7c7b\uff0c\u907f\u514d\u4f7f\u7528\u5bf9\u80ce\u513f\u6709\u98ce\u9669\u7684\u836f\u7269\uff0c\u5982\u56db\u73af\u7d20\u7c7b\u548c\u55b9\u8bfa\u916e\u7c7b\u3002\u5fc5\u8981\u65f6\uff0c\u53ef\u6839\u636e\u75c5\u539f\u4f53\u53ca\u836f\u654f\u7ed3\u679c\uff0c\u9009\u62e9\u5927\u73af\u5185\u916f\u7c7b\u548c \u03b2 <\/b>–<\/b>\u5185\u9170\u80fa\u9176\u6291\u5236\u5242\u3002\u5bf9\u4e8e\u54fa\u4e73\u671f <\/b>CAP <\/b>\u60a3\u8005\uff0c\u63a8\u8350\u4f7f\u7528\u4e73\u6c41\u4e2d\u6d53\u5ea6\u4f4e\u3001\u5bf9\u5a74\u513f\u5f71\u54cd\u5c0f\u7684\u6297\u751f\u7d20\uff0c\u5982\u9752\u9709\u7d20\u7c7b\u3001\u5934\u5b62\u83cc\u7d20\u7c7b\u548c\u5927\u73af\u5185\u916f\u7c7b\u3002\u5982\u9700\u4f7f\u7528\u5bf9\u5a74\u513f\u6709\u8f83\u9ad8\u98ce\u9669\u7684\u836f\u7269\uff0c\u5efa\u8bae\u6682\u505c\u6bcd\u4e73\u5582\u517b\uff08\u8bc1\u636e\u7b49\u7ea7\u2162\uff0c\u63a8\u8350\u7b49\u7ea7 <\/b>B<\/b>\uff09\u3002<\/b><\/b><\/p>\n

\u63a8\u8350\u610f\u89c1 14 \uff1a<\/b> \u8f7b\u4e2d\u5ea6 <\/b>CAP <\/b>\u60a3\u8005\uff0c\u4f53\u6e29\u6b63\u5e38 <\/b>48~72 h<\/b>\uff0c\u4e34\u5e8a\u60c5\u51b5\u7a33\u5b9a\uff0c\u53ef\u8003\u8651\u505c\u7528\u6297\u751f\u7d20\uff0c\u4e00\u822c\u7597\u7a0b <\/b>5~7 d<\/b>\u3002\u5bf9\u4e8e\u91cd\u75c7\u60a3\u8005\uff0c\u9664\u6ee1\u8db3\u4e0a\u8ff0\u6761\u4ef6\u5916\uff0c <\/b>CPIS <\/b>\u8bc4\u5206<\/b>\u2264 <\/b>6 <\/b>\u5206\uff08\u8868<\/b>11<\/b>\uff09\uff0c\u53ef\u8003\u8651\u505c\u836f\u3002\u5bf9\u4e8e\u975e\u5178\u578b\u75c5\u539f\u4f53\u611f\u67d3\uff08\u5982\u55dc\u80ba\u519b\u56e2\u83cc\u3001\u9e66\u9e49\u70ed\u8863\u539f\u4f53\u7b49\uff09\uff0c\u4e00\u822c\u7597\u7a0b <\/b>7~10 d<\/b>\u3002\u514d\u75ab\u6291\u5236\u3001\u91cd\u75c7\u60a3\u8005\uff0c\u6216\u5b58\u5728\u80ba\u8113\u80bf\u3001\u8113\u80f8\u3001\u5fc3\u5185\u819c\u708e\u7b49\u5e76\u53d1\u75c7\u7684\u60a3\u8005\uff0c\u7597\u7a0b\u53ef\u5ef6\u957f\u81f3 <\/b>14~21 d<\/b>\uff08\u8bc1\u636e\u7b49\u7ea7\u2161\uff0c\u63a8\u8350\u7b49\u7ea7 <\/b>B<\/b>\uff09<\/b> <\/b><\/p>\n

7 \u6210\u4eba CAP \u76ee\u6807\u6027\u6297\u611f\u67d3\u6cbb\u7597<\/b><\/p>\n

\u5728\u786e\u8ba4 CAP \u75c5\u539f\u4f53\u540e\uff0c\u5e94\u6839\u636e\u836f\u654f\u6d4b\u8bd5\u7ed3\u679c\u53ca\u60a3\u8005\u60c5\u51b5\u9009\u62e9\u6cbb\u7597\u65b9\u6848\u3002\u5173\u4e8e CAP \u4e3b\u8981\u75c5\u539f\u83cc\u3001\u63a8\u8350\u7684\u6297\u611f\u67d3\u836f\u7269\u53ca\u5176\u4f7f\u7528\u65b9\u6cd5\uff0c\u8bf7\u53c2\u89c1\u9644\u5f55\u88682\u3002<\/p>\n

8 \u6210\u4eba CAP \u7efc\u5408\u6cbb\u7597<\/b><\/b><\/p>\n

8.1 \u6c14\u9053\u7ba1\u7406<\/p>\n

\u7ef4\u6301\u547c\u5438\u9053\u901a\u7545\u5bf9 CAP \u60a3\u8005\u81f3\u5173\u91cd\u8981\uff0c\u5c24\u5176\u662f\u5b58\u5728\u54b3\u75f0\u65e0\u529b\u7684\u8001\u5e74\u4eba\uff0c\u6216\u5e76\u5b58\u4e2d\u67a2\u795e\u7ecf\u7cfb\u7edf\u75be\u60a3\u7684\u60a3\u8005\u3002\u5e94\u5631\u60a3\u8005\u91c7\u53d6\u6700\u6709\u5229\u4e8e\u547c\u5438\u9053\u901a\u7545\u7684\u4f53\u4f4d\uff0c\u9f13\u52b1\u7528\u529b\u54b3\u55fd\u6392\u75f0\uff0c\u82e5\u75f0\u6db2\u4e0d\u6613\u54b3\u51fa\uff0c\u53ef\u7ed9\u4e88\u5168\u8eab\u6216\u5c40\u90e8\u7684\u795b\u75f0\u6cbb\u7597\uff0c\u4eba\u5de5\u3001\u673a\u68b0\u6392\u75f0\u548c\u4f53\u4f4d\u75f0\u6db2\u5f15\u6d41\u7b49\uff0c\u5fc5\u8981\u65f6\u53ef\u7ed9\u4e88\u652f\u6c14\u7ba1\u6269\u5f20\u5242\u548c\u6fc0\u7d20\u96fe\u5316\u5438\u5165\uff0c\u4ee5\u7ef4\u6301\u547c\u5438\u9053\u6e7f\u5316\u548c\u89e3\u9664\u6c14\u9053\u75c9\u631b\u3002\u6c14\u7ba1\u63d2\u7ba1\u60a3\u8005\uff0c\u5fc5\u8981\u65f6\u53ef\u4e88\u7ea4\u652f\u955c\u4e0b\u5438\u75f0\u53ca\u652f\u6c14\u7ba1\u80ba\u6ce1\u704c\u6d17\u672f\u3002\u6e05\u9192\u4fef\u5367\u4f4d\u6216\u6c14\u7ba1\u63d2\u7ba1\u60a3\u8005\u7684\u4fef\u5367\u4f4d\u901a\u6c14\u53ef\u4fc3\u8fdb\u75f0\u6db2\u5f15\u6d41\u3002<\/p>\n

8.2 \u547c\u5438\u652f\u6301<\/p>\n

CAP \u60a3\u8005\u5e94\u53ca\u65f6\u8bc4\u4f30\u8840\u6c27\u6c34\u5e73\uff0c\u5b58\u5728\u4f4e\u6c27\u8840\u75c7\u7684\u60a3\u8005\u63a8\u8350\u9f3b\u5bfc\u7ba1\u6216\u9762\u7f69\u6c27\u7597\uff0c\u7ef4\u6301\u8840\u6c27\u9971\u548c\u5ea6\u5728 90% \u4ee5\u4e0a\u3002\u76f8\u5bf9\u4e8e\u666e\u901a\u6c27\u7597\uff0c\u7ecf\u9f3b\u9ad8\u6d41\u91cf\u6c27\u7597\uff08high-flow nasal cannula oxygen therapy, HFNC\uff09\u5177\u6709\u53ef\u63a7\u6027\u7cbe\u51c6\u7ed9\u6c27\u3001\u5145\u5206\u52a0\u6e29\u6e7f\u5316\u3001\u51cf\u5c11\u89e3\u5256\u6b7b\u8154\u3001\u4ea7\u751f\u4e00\u5b9a\u7684\u6c14\u9053\u6b63\u538b\u3001\u589e\u52a0\u547c\u6c14\u672b\u80ba\u5bb9\u79ef\u53ca\u964d\u4f4e\u547c\u5438\u529f\u7b49\u4f18\u52bf\u3002\u5728 CAP \u60a3\u8005\u4e2d\uff0c\u7814\u7a76\u53d1\u73b0 HFNC \u8f83\u666e\u901a\u6c27\u7597\u66f4\u8212\u9002\u3001\u6c27\u5408\u66f4\u4f73\u4e14\u53ef\u4ee5\u964d\u4f4e\u547c\u5438\u9891\u7387\uff0c\u53ef\u80fd\u964d\u4f4e\u60a3\u8005\u547c\u5438\u652f\u6301\u5347\u7ea7\u7684\u9700\u6c42\u3002ROX \u6307\u6570 [SpO2\uff08\/ FiO2\u00d7 RR\uff09]\u662f\u4e00\u4e2a\u6709\u52a9\u4e8e\u8bc6\u522b\u63d2\u7ba1\u98ce\u9669\u7684\u6307\u6807\uff0c\u5728HFNC\u542f\u52a8\u540e2 h\u30016 h\u300112 h \u65f6 ROX \u2265 4.88 \u4e0e\u66f4\u4f4e\u7684\u63d2\u7ba1\u98ce\u9669\u76f8\u5173\u3002\u6709\u7814\u7a76\u63d0\u51fa VOX \u6307\u6570 [\uff08SpO2\/FiO2\uff09 \/VT] \u5728\u9884\u6d4b HFNC \u6210\u8d25\u7684\u80fd\u529b\u4f18\u4e8e ROX \u6307\u6570\uff0c 2 h \u65f6 VOX \u6307\u6570 >20.91 \u53ca 6 h \u65f6 VOX \u6307\u6570 >22.67 \u53ef\u9884\u6d4b HFNC \u8f83\u9ad8\u7684\u6210\u529f\u7387\u3002<\/p>\n

\u4e0e\u9ad8\u6d53\u5ea6\u6c27\u7597\u76f8\u6bd4\uff0c\u65e0\u521b\u673a\u68b0\u901a\u6c14\uff08NIV\uff09\u80fd\u964d\u4f4eCAP \u5408\u5e76\u6025\u6027\u547c\u5438\u8870\u7aed\u60a3\u8005\u7684\u6c14\u7ba1\u63d2\u7ba1\u7387\u548c\u75c5\u6b7b\u7387\uff0c\u4f7f\u6c27\u5408\u6307\u6570\u5f97\u5230\u66f4\u5feb\u3001\u66f4\u660e\u663e\u7684\u6539\u5584\uff0c\u4f46\u91cd\u5ea6\u4f4e\u6c27 CAP \u60a3\u8005\uff08PaO2\/FiO2<150 mmHg\uff09\u5219\u5e94\u8c28\u614e\u4f7f\u7528 NIV\u3002\u7b26\u5408\u4ee5\u4e0b\u6761\u4ef6\u8005\u53ef\u8bd5\u884c NIV\uff1a\u2474\u60a3\u8005\u6e05\u9192\u5408\u4f5c\uff0c\u75c5\u60c5\u76f8\u5bf9\u7a33\u5b9a\uff1b\u2475\u65e0\u75f0\u6216\u75f0\u6db2\u6e05\u9664\u80fd\u529b\u597d\uff1b\u2476\u65e0\u591a\u5668\u5b98\u529f\u80fd\u8870\u7aed\uff1b\u2477\u7b80\u660e\u6025\u6027\u751f\u7406\u5b66\u8bc4\u5206\uff08SAPS \u2161\uff09 <34 \uff1b\u2478 NIV \u6cbb\u7597 1~2 h \u540ePaO2\/FiO2>175 mmHg\u3002\u82e5\u4f7f\u7528 NIV \u6700\u521d 1~2 h \u4e0d\u80fd\u6539\u5584\u60a3\u8005\u7684\u547c\u5438\u9891\u7387\u548c\u6c27\u5408\u72b6\u6001\uff0c\u6216\u4e0d\u80fd\u964d\u4f4e\u521d\u59cb\u9ad8\u78b3\u9178\u8840\u75c7\u60a3\u8005\u7684\u8840\u4e8c\u6c27\u5316\u78b3\u6c34\u5e73\uff0c\u5e94\u53ca\u65f6\u6539\u4e3a\u6709\u521b\u673a\u68b0\u901a\u6c14\u3002<\/p>\n

\u91cd\u75c7 CAP \u60a3\u8005\u82e5\u4f34\u6709\u4e25\u91cd\u547c\u5438\u8870\u7aed\uff0c\u9700\u884c\u6c14\u7ba1\u63d2\u7ba1\u548c\u673a\u68b0\u901a\u6c14\u3002\u5e94\u91c7\u7528\u80ba\u4fdd\u62a4\u6027\u901a\u6c14\u7b56\u7565\uff0c\u7279\u522b\u662f\u6025\u6027\u547c\u5438\u7a98\u8feb\u7efc\u5408\u5f81\uff08acute respiratory distress syndrome, ARDS\uff09\u7684\u60a3\u8005\u3002\u63a8\u8350\u4f7f\u7528\u5c0f\u6f6e\u6c14\u91cf\u673a\u68b0\u901a\u6c14\uff086 mL\/kg \u7406\u60f3\u4f53\u91cd\uff09\uff0c\u5e76\u6839\u636e\u4f4e\u6c27\u8840\u75c7\u7684\u4e25\u91cd\u7a0b\u5ea6\u3001\u80ba\u987a\u5e94\u6027\u7b49\u56e0\u7d20\u9009\u62e9\u9002\u5f53\u7684\u547c\u6c14\u672b\u6b63\u538b\uff08PEEP\uff09\u3002\u5e94\u7ed9\u4e88\u9002\u5f53\u7684\u9547\u9759\u9547\u75db\u6cbb\u7597\uff1b\u5bf9\u4e8e\u81ea\u4e3b\u547c\u5438\u9a71\u52a8\u8fc7\u5f3a\u8005\u53ef\u4e88\u808c\u677e\u6cbb\u7597\u3002\u5e94\u6ce8\u610f\u907f\u514d\u8fc7\u5ea6\u9547\u9759\u548c\u808c\u677e\uff0c\u75c5\u60c5\u5141\u8bb8\u53ca\u65f6\u6062\u590d\u81ea\u4e3b\u547c\u5438\u3002 ARDS \u60a3\u8005\u9700\u9650\u5236\u5e73\u53f0\u538b\u572830 cmH2O\uff081 cmH2O=0.098 kPa\uff09\u4ee5\u4e0b\uff0c\u9a71\u52a8\u538b\uff08\u5e73\u53f0\u538b-PEEP\uff09\u9650\u5236\u5728 15 cmH2O \u4ee5\u4e0b\uff0c\u4ee5\u964d\u4f4e\u75c5\u6b7b\u7387\uff0c\u51cf\u8f7b\u547c\u5438\u673a\u76f8\u5173\u80ba\u635f\u4f24\u3002\u5728\u91cd\u5ea6 ARDS \u60a3\u8005\u4e2d\uff0c\u65e9\u671f\u4fef\u5367\u4f4d\u901a\u6c14\uff0816 h\/d \u4ee5\u4e0a\uff09\u53ef\u663e\u8457\u964d\u4f4e\u75c5\u6b7b\u7387\u3002<\/p>\n

\u91cd\u75c7 CAP \u53ef\u5bfc\u81f4\u4e25\u91cd\u5e76\u53d1\u75c7\uff0c\u4f8b\u5982 ARDS\u3001\u4e25\u91cd\u5fc3\u529f\u80fd\u4e0d\u5168\u3001\u8113\u6bd2\u6027\u4f11\u514b\u7b49\uff0c\u5728\u6700\u4f18\u5316\u7684\u673a\u68b0\u901a\u6c14\u6761\u4ef6\u4e14\u91c7\u7528\u4fef\u5367\u4f4d\u901a\u6c14\u540e\u4ecd\u7136\u65e0\u6cd5\u4f7f\u75c5\u60c5\u5f97\u5230\u7f13\u89e3\u7684\u60c5\u51b5\u4e0b\uff0c\u53ef\u4ee5\u8003\u8651\u5bf9\u9002\u5408\u7684\u60a3\u8005\u5b9e\u65bd\u4f53\u5916\u819c\u80ba\u6c27\u5408\uff08ECMO\uff09\u6cbb\u7597\u3002\u91cd\u75c7CAP \u5408\u5e76 ARDS \u60a3\u8005\u884c ECMO \u7684\u6307\u5f81\uff1a\u2474 PaO2\/FiO2<80 mmHg\uff0c\u6301\u7eed\u8d85\u8fc7 6 h\uff1b\u6216 PaO2\/FiO2<50 mmHg\uff0c\u6301\u7eed\u8d85\u8fc73 h\uff1b\u2475 pH \u503c <7.25\uff0c\u4e14 PaCO2 \u226560 mmHg\uff0c\u6301\u7eed\u8d85\u8fc7 6 h\uff0c\u540c\u65f6\u547c\u5438\u9891\u7387\u5347\u81f3 35 \u6b21 \/min \u4e14\u673a\u68b0\u901a\u6c14\u8bbe\u7f6e\u8c03\u6574\u81f3\u7ef4\u6301\u5e73\u53f0\u538b\u226432 cmH2O \uff1b\u2476\u673a\u68b0\u901a\u6c14\u65f6\u95f4 <7 d\u3002<\/p>\n

\u63a8\u8350\u610f\u89c1 15 \uff1a<\/b> <\/b>CAP <\/b>\u60a3\u8005\u4e2d\uff0c\u5bf9\u4e8e\u65e0\u9700\u7acb\u5373\u6c14\u7ba1\u63d2\u7ba1\u7684\u6025\u6027\u2160\u578b\u547c\u5438\u8870\u7aed\u60a3\u8005\uff0c\u63a8\u8350\u6709\u6761\u4ef6\u65f6\u4f7f\u7528\u9ad8\u6d41\u91cf\u6c27\u7597\u4ee3\u66ff\u666e\u901a\u6c27\u7597\u3002\u5bf9\u4e8e\u65e0\u9700\u7acb\u5373\u6c14\u7ba1\u63d2\u7ba1\u7684\u6301\u7eed\u2160\u578b\u547c\u5438\u8870\u7aed\u6216\u6025\u6027\u2161\u578b\u547c\u5438\u8870\u7aed\u60a3\u8005\uff0c\u63a8\u8350\u9996\u9009\u65e0\u521b\u673a\u68b0\u901a\u6c14\u3002\u91cd\u75c7 <\/b>CAP<\/b>\u60a3\u8005\u5982\u4f34\u6709\u4e25\u91cd\u7684\u547c\u5438\u8870\u7aed\uff0c\u5e94\u884c\u6709\u521b\u673a\u68b0\u901a\u6c14\uff0c <\/b>ARDS <\/b>\u8005\u91c7\u7528\u5c0f\u6f6e\u6c14\u91cf\u884c\u80ba\u4fdd\u62a4\u6027\u901a\u6c14\uff0c\u5c06\u5e73\u53f0\u538b <\/b>\/ <\/b>\u9a71\u52a8\u538b\u9650\u5236\u5728<\/b>30\/15 cmH2O <\/b>\u4ee5\u4e0b\uff0c\u91cd\u5ea6 <\/b>ARDS <\/b>\u8005\u9002\u65f6\u5e94\u7528\u808c\u677e\u5242\u548c\u4fef\u5367\u4f4d\u901a\u6c14\u3002\u91cd\u75c7 <\/b>CAP <\/b>\u60a3\u8005\u5408\u5e76 <\/b>ARDS<\/b>\u3001\u4e25\u91cd\u5fc3\u529f\u80fd\u4e0d\u5168\u7b49\uff0c\u7efc\u5408\u6cbb\u7597\u65e0\u6548\u65f6\u53ef\u8003\u8651\u5b9e\u65bd <\/b>ECMO<\/b>\uff08\u8bc1\u636e\u7b49\u7ea7\u2161\uff0c\u63a8\u8350\u7b49\u7ea7 <\/b>A<\/b>\uff09\u3002<\/b><\/b><\/p>\n

8.3 \u7cd6\u76ae\u8d28\u6fc0\u7d20<\/p>\n

\u8fd1\u5e74\u6765\uff0c\u652f\u6301\u5728\u91cd\u75c7 CAP \u60a3\u8005\u4e2d\u4f7f\u7528\u5c0f\u5242\u91cf\u7cd6\u76ae\u8d28\u6fc0\u7d20\u7684\u7814\u7a76\u9010\u6b65\u589e\u591a\u3002\u835f\u8403\u5206\u6790\u8868\u660e\uff0c\u6c22\u5316\u53ef\u7684\u677e\u2264 400 mg\/d \u6cbb\u7597\u2264 8 d \u53ef\u964d\u4f4e\u91cd\u75c7\u7ec6\u83cc\u6027 CAP \u60a3\u8005 30 d \u75c5\u6b7b\u7387\u3002\u4f4e\u5242\u91cf\u7cd6\u76ae\u8d28\u6fc0\u7d20\u6cbb\u7597\u53ef\u80fd\u5bf9\u5408\u5e76\u8113\u6bd2\u6027\u4f11\u514b\u3001ARDS \u6216\u4e24\u8005\u517c\u6709\u7684\u547c\u5438\u9053\u611f\u67d3\u5371\u91cd\u60a3\u8005\u6709\u5229\u3002\u4f46\u5e94\u6ce8\u610f\uff0c\u4f4e\u5242\u91cf\u7cd6\u76ae\u8d28\u6fc0\u7d20\u6cbb\u7597\u53ef\u80fd\u4f34\u968f\u591a\u79cd\u4e0d\u826f\u53cd\u5e94\uff0c\u5305\u62ec\u9ad8\u8840\u7cd6\u3001\u6d88\u5316\u9053\u51fa\u8840\u3001\u795e\u7ecf\u7cbe\u795e\u969c\u788d\u3001\u808c\u8089\u65e0\u529b\u3001\u9ad8\u94a0\u8840\u75c7\u4ee5\u53ca\u7ee7\u53d1\u611f\u67d3\u3002\u5bf9\u4e8e\u514d\u75ab\u529f\u80fd\u7f3a\u9677\u7684\u60a3\u8005\uff0c\u5e94\u614e\u7528\u7cd6\u76ae\u8d28\u6fc0\u7d20\u3002\u603b\u4e4b\uff0c\u7cd6\u76ae\u8d28\u6fc0\u7d20\u5728 CAP \u7684\u6cbb\u7597\u4e2d\u5e94\u6743\u8861\u5229\u5f0a\uff0c\u5e94\u6839\u636e\u75c5\u60c5\u4e25\u91cd\u5ea6\u3001\u5e76\u53d1\u75c7\u3001\u514d\u75ab\u529f\u80fd\u3001\u5668\u5b98\u529f\u80fd\u548c\u6709\u65e0\u7981\u5fcc\u8bc1\u7b49\u505a\u51fa\u7efc\u5408\u8bc4\u4f30\u3002<\/p>\n

\u63a8\u8350\u610f\u89c1 16 \uff1a <\/b>\u5bf9\u4e8e\u8f7b\u75c7 <\/b>CAP <\/b>\u60a3\u8005\u4e0d\u5efa\u8bae\u5e38\u89c4\u4f7f\u7528\u7cd6\u76ae\u8d28\u6fc0\u7d20 \uff1b\u5bf9\u4e8e\u91cd\u75c7 <\/b>CAP<\/b>\uff0c\u7279\u522b\u662f\u5408\u5e76\u8113\u6bd2\u6027\u4f11\u514b\u6216<\/b>ARDS <\/b>\u7684\u60a3\u8005\uff0c\u53ef\u8003\u8651\u5c0f\u5242\u91cf\u77ed\u7597\u7a0b\u4f7f\u7528\u7cd6\u76ae\u8d28\u6fc0\u7d20\u3002\uff08\u8bc1\u636e\u7b49\u7ea7\u2161\uff0c\u63a8\u8350\u7b49\u7ea7 <\/b>B<\/b>\uff09<\/b><\/b><\/p>\n

8.4 \u5bb9\u91cf\u7ba1\u7406<\/p>\n

\u9650\u5236\u6027\u6db2\u4f53\u7ba1\u7406\u662f\u5728\u8840\u6d41\u52a8\u529b\u5b66\u76d1\u6d4b\u4e0b\uff0c\u7ec4\u7ec7\u704c\u6ce8\u57fa\u672c\u5f97\u5230\u4fdd\u8bc1\u7684\u57fa\u7840\u4e0a\uff0c\u673a\u4f53\u7ef4\u6301\u8f83\u4f4e\u7684\u524d\u8d1f\u8377\u6307\u6807\uff0c\u5fc5\u8981\u65f6\u5e94\u7528\u5229\u5c3f\u5242\u6216\u6301\u7eed\u80be\u810f\u66ff\u4ee3\u7597\u6cd5\u6765\u5b9e\u73b0\u6db2\u4f53\u51fa\u5165\u91cf\u96f6\u5e73\u8861\u6216\u8d1f\u5e73\u8861\uff0c\u5df2\u88ab\u8bc1\u5b9e\u53ef\u4f7f ARDS \u60a3\u8005\u83b7\u76ca\u3002\u9650\u5236\u6027\u6db2\u4f53\u7ba1\u7406\u3001\u9002\u65f6\u6db2\u4f53\u8d1f\u5e73\u8861\u5728 CAP \u4e2d\u53ef\u6539\u5584\u80ba\u987a\u5e94\u6027\u3001\u589e\u5f3a\u6297\u611f\u67d3\u6548\u679c\u3001\u6539\u5584\u5fc3\u529f\u80fd\u53ca\u4fdd\u62a4\u80ba\u95f4\u8d28\u7ed3\u6784\u5b8c\u6574\u6027\u3002<\/p>\n

\u63a8\u8350\u610f\u89c1 17 \uff1a<\/b> \u5bf9\u4e8e\u91cd\u75c7 <\/b>CAP <\/b>\u60a3\u8005\uff0c\u4ee5\u5faa\u73af\u7a33\u5b9a\u4e3a\u524d\u63d0\u7684\u6db2\u4f53\u8d1f\u5e73\u8861\u53ef\u6539\u5584\u80ba\u987a\u5e94\u6027\uff0c\u51cf\u8f7b\u80ba\u6c34\u80bf\uff0c\u6539\u5584\u5fc3\u529f\u80fd\uff0c\u6709\u5229\u4e8e\u8131\u79bb\u547c\u5438\u673a\u53ca\u611f\u67d3\u7684\u63a7\u5236\uff08\u8bc1\u636e\u7b49\u7ea7\u2162\uff0c\u63a8\u8350\u7b49\u7ea7 <\/b>B<\/b>\uff09\u3002<\/b><\/b><\/p>\n

8.5 \u80ba\u5eb7\u590d<\/p>\n

\u80ba\u5eb7\u590d\u5728\u6539\u5584 CAP \u60a3\u8005\u80ba\u529f\u80fd\u65b9\u9762\u7684\u4ef7\u503c\u53d7\u5230\u4e34\u5e8a\u8ba4\u53ef\u4e0e\u80af\u5b9a\uff0c\u5177\u4f53\u65b9\u6cd5\u5305\u62ec\u8fd0\u52a8\u953b\u70bc\u3001\u547c\u5438\u8bad\u7ec3\u3001\u54b3\u75f0\u8bad\u7ec3\u3001\u8425\u517b\u7597\u6cd5\u7b49\u3002\u901a\u8fc7\u8fd9\u4e9b\u4e2a\u4f53\u5316\u7684\u7efc\u5408\u80ba\u5eb7\u590d\u6cbb\u7597\u624b\u6bb5\uff0c\u53ef\u4ee5\u4fc3\u8fdb\u60a3\u8005\u5fc3\u80ba\u8010\u529b\u6539\u5584\uff0c\u8f85\u52a9\u539f\u53d1\u75c5\u6cbb\u7597\u3002<\/p>\n

8.6 \u9759\u8109\u8840\u6813\u6813\u585e\u9884\u9632<\/p>\n

\u5bf9\u4f4f\u9662 CAP \u60a3\u8005\u5efa\u8bae\u91c7\u7528 Caprini \u8bc4\u5206\u6216 Padua \u8bc4\u5206\u8fdb\u884c\u6df1\u9759\u8109\u8840\u6813\u5f62\u6210\u98ce\u9669\u8bc4\u4f30\uff0c\u5e76\u5bf9\u51fa\u8840\u98ce\u9669\u8fdb\u884c\u8bc4\u4f30\uff0c\u5236\u8ba2\u6709\u9488\u5bf9\u6027\u7684\u9884\u9632\u548c\u6cbb\u7597\u7b56\u7565\u3002\u4f4e\u5371\u60a3\u8005\u9f13\u52b1\u4e0b\u5e8a\u6d3b\u52a8\uff0c\u5367\u5e8a\u65f6\u8fdb\u884c\u8e1d\u6cf5\u8fd0\u52a8\u3001\u80a1\u56db\u5934\u808c\u529f\u80fd\u953b\u70bc\u6765\u5b9e\u65bd\u57fa\u672c\u9884\u9632\u3002\u4e2d\u5371\u60a3\u8005\u4e14\u51fa\u8840\u98ce\u9669\u4f4e\u8005\uff0c\u53ef\u4e88\u836f\u7269\u6216\u673a\u68b0\u9884\u9632\u3002\u6297\u51dd\u836f\u7269\u53ef\u9009\u62e9\u666e\u901a\u809d\u7d20\u3001\u4f4e\u5206\u5b50\u809d\u7d20\u6216\u65b0\u578b\u53e3\u670d\u6297\u51dd\u836f\u3002\u9ad8\u5371\u4e14\u51fa\u8840\u98ce\u9669\u4f4e\u7684\u60a3\u8005\uff0c\u5e94\u4e88\u836f\u7269\u9884\u9632\uff0c\u6216\u8054\u5408\u673a\u68b0\u9884\u9632\u3002\u4e2d\u9ad8\u5371\u60a3\u8005\u4e14\u51fa\u8840\u98ce\u9669\u9ad8\u8005\uff0c\u5efa\u8bae\u8fdb\u884c\u673a\u68b0\u9884\u9632\u3002<\/p>\n

8.7 \u8425\u517b\u652f\u6301\u6cbb\u7597<\/p>\n

\u65e9\u671f\u80a0\u5185\u8425\u517b\u6807\u51c6\u5316\u5582\u517b\u6d41\u7a0b\u53ef\u4fc3\u8fdb\u91cd\u75c7 CAP \u60a3\u8005\u80ba\u529f\u80fd\u6062\u590d\uff0c\u6539\u5584\u60a3\u8005\u9884\u540e\u3002\u91cd\u75c7 CAP \u60a3\u8005\u6613\u51fa\u73b0\u5e94\u6fc0\u6027\u9ad8\u8840\u7cd6\uff0c\u4e3a\u9884\u540e\u4e0d\u826f\u7684\u5371\u9669\u56e0\u7d20\uff0c\u8425\u517b\u6cbb\u7597\u65f6\u5e94\u907f\u514d\u8840\u7cd6\u663e\u8457\u6ce2\u52a8\u3002\u8001\u5e74\u6216\u91cd\u75c7 CAP \u60a3\u8005\u5efa\u8bae\u65e9\u671f\u8425\u517b\u7b5b\u67e5\u3001\u9488\u5bf9\u6027\u5b9e\u65bd\u8425\u517b\u6cbb\u7597\u3002<\/p>\n

8.8 \u514d\u75ab\u8c03\u8282\u6cbb\u7597<\/p>\n

\u7ec6\u80de\u514d\u75ab\u529f\u80fd\u7d0a\u4e71\u4e3a CAP \u4e0d\u826f\u9884\u540e\u7684\u5371\u9669\u56e0\u7d20\uff0c\u8c03\u8282\u7ec6\u80de\u514d\u75ab\u529f\u80fd\u5bf9\u9884\u540e\u53ef\u80fd\u5177\u6709\u79ef\u6781\u610f\u4e49\u3002\u76ee\u524d\u5c1a\u7f3a\u4e4fCAP \u60a3\u8005\u514d\u75ab\u4f4e\u4e0b\u7684\u8bca\u65ad\u6807\u51c6\uff0c\u6709\u7814\u7a76\u63d0\u793a\u5927\u73af\u5185\u916f\u7c7b\u6297\u751f\u7d20\u7684\u514d\u75ab\u8c03\u8282\u4f5c\u7528\u5728 CAP \u7684\u6cbb\u7597\u4e2d\u6709\u4e00\u5b9a\u4e34\u5e8a\u4ef7\u503c\u3002\u5176\u4f59\u514d\u75ab\u6cbb\u7597\u5982\u514d\u75ab\u7403\u86cb\u767d\u3001\u80f8\u817a\u80bd\u7b49\uff0c\u9700\u66f4\u591a\u5927\u89c4\u6a21\u4e34\u5e8a\u8bd5\u9a8c\u6765\u9a8c\u8bc1\u5176\u5728 CAP \u4e2d\u7684\u6709\u6548\u6027\u548c\u5b89\u5168\u6027\u3002<\/p>\n

8.9 \u4e2d\u533b\u836f\u8f85\u52a9\u6cbb\u7597<\/p>\n

\u4e2d\u533b\u5b66\u8ba4\u4e3a CAP \u53d1\u75c5\u4e3b\u8981\u7531\u4e8e\u5916\u90aa\u4fb5\u88ad\u3001\u80ba\u536b\u53d7\u90aa\uff0c\u6216\u6b63\u6c14\u865a\u5f31\u3001\u6297\u90aa\u65e0\u529b\u4e24\u4e2a\u65b9\u9762\u3002\u5f53\u4ee5\u8fa8\u8bc1\u8bba\u6cbb\u4e3a\u4e3b\uff0c CAP \u4e34\u5e8a\u5e38\u89c1\u8bc1\u578b\u5305\u62ec\u5b9e\u8bc1\u7c7b\uff08\u98ce\u70ed\u72af\u80ba\u8bc1\u3001\u5916\u5bd2\u5185\u70ed\u8bc1\u3001\u75f0\u70ed\u58c5\u80ba\u8bc1\u3001\u75f0\u6d4a\u963b\u80ba\u8bc1\uff09\u3001\u6b63\u865a\u90aa\u604b\u7c7b\uff08\u80ba\u813e\u6c14\u865a\u8bc1\u3001\u6c14\u9634\u4e24\u865a\u8bc1\uff09\u3001\u5371\u91cd\u53d8\u8bc1\u7c7b\uff08\u70ed\u9677\u5fc3\u5305\u8bc1\u3001\u90aa\u9677\u6b63\u8131\u8bc1\uff09 3 \u7c7b8 \u4e2a\u8bc1\u578b\u3002\u6025\u8bca\u8fd0\u7528\u4e2d\u533b\u836f\u6cbb\u7597\u65f6\uff0c\u6cbb\u6cd5\u5e94\u6839\u636e\u4e0d\u540c\u8bc1\u578b\u7075\u6d3b\u8c03\u6574\uff0c\u4ea6\u53ef\u6839\u636e\u75c5\u60c5\u9009\u62e9\u76f8\u5173\u4e2d\u6210\u836f\uff08\u75f0\u70ed\u6e05\u6ce8\u5c04<\/p>\n

\u6db2\u3001\u70ed\u6bd2\u5b81\u6ce8\u5c04\u6db2\u3001\u8840\u5fc5\u51c0\u6ce8\u5c04\u6db2\u3001\u53c2\u9644\u6ce8\u5c04\u6db2\u3001\u53c2\u9ea6\u6ce8\u5c04\u6db2\u7b49\uff09\u8f85\u52a9\u6cbb\u7597\u3002<\/p>\n

\u63a8\u8350\u610f\u89c1 18 \uff1a <\/b>\u91cd\u75c7 <\/b>CAP <\/b>\u60a3\u8005\u9700\u8981\u7efc\u5408\u6cbb\u7597\uff0c\u5e94\u91cd\u89c6\u80ba\u5eb7\u590d\u3001\u8425\u517b\u6cbb\u7597\u548c\u9884\u9632\u9759\u8109\u8840\u6813\u6813\u585e\uff0c\u53ef\u9002\u65f6\u5e94\u7528\u4e2d\u533b\u836f\u8f85\u52a9\u6cbb\u7597\uff0c\u4e0d\u63a8\u8350\u5e38\u89c4\u5e94\u7528\u514d\u75ab\u8c03\u8282\u6cbb\u7597\uff08\u8bc1\u636e\u7b49\u7ea7\u2162\uff0c\u63a8\u8350\u7b49\u7ea7 <\/b>B<\/b>\uff09\u3002<\/b><\/b><\/p>\n

8.10 \u76f8\u5173\u810f\u5668\u529f\u80fd\u652f\u6301\u6cbb\u7597<\/p>\n

\u91cd\u75c7 CAP \u5bb9\u6613\u5e76\u53d1\u8113\u6bd2\u6027\u4f11\u514b\uff0c\u5728\u79ef\u6781\u6297\u83cc\u6cbb\u7597\u7684\u540c\u65f6\uff0c\u5e94\u53ca\u65f6\u7ed9\u4e88\u6db2\u4f53\u590d\u82cf\u548c\u8840\u7ba1\u6d3b\u6027\u836f\u7269\uff0c\u9075\u5faa\u8113\u6bd2\u75c7\u7684\u6cbb\u7597\u539f\u5219\u3002\u5bf9\u4e8e\u6025\u8bca\u975e\u91cd\u75c7 CAP \u60a3\u8005\uff0c\u9700\u6ce8\u610f\u8113\u6bd2\u75c7\u7684\u9632\u6cbb\uff0c\u5176\u4e2d PCT \u548c\u4e73\u9178\u662f\u76ee\u524d\u6bd4\u8f83\u516c\u8ba4\u7684\u9884\u6d4b\u548c\u6cbb\u7597\u6307\u6807\u3002\u7ea6 30% \u7684 CAP \u60a3\u8005\u5728\u6025\u6027\u671f\u53ca\u5176\u540e\u6570\u5e74\u5185\u53ef\u80fd\u51fa\u73b0\u5fc3\u8840\u7ba1\u5e76\u53d1\u75c7\uff08\u5982\u65b0\u53d1\u6216\u52a0\u91cd\u7684\u5fc3\u529b\u8870\u7aed\u3001\u5fc3\u5f8b\u5931\u5e38\u3001\u5fc3\u808c\u6897\u6b7b\u7b49\uff09\uff0c\u4e0e\u9884\u540e\u5bc6\u5207\u76f8\u5173\uff0c\u6025\u8bca\u8bca\u7597\u65f6\u9700\u91c7\u53d6\u5fc5\u8981\u7684\u76d1\u6d4b\u548c\u9632\u6cbb\u63aa\u65bd\u3002\u5bf9\u4e8e\u91cd\u75c7 CAP \u60a3\u8005\uff0c\u9700\u8b66\u60d5\u8113\u6bd2\u75c7\u5fc3\u808c\u75c5\u548c\u6025\u6027\u5fc3\u808c\u708e\u7684\u53d1\u751f\u3002\u5bf9\u4e8e\u6709\u51a0\u5fc3\u75c5\u57fa\u7840\u7684\u60a3\u8005\uff0c\u5e94\u7ee7\u7eed\u8fdb\u884c\u51a0\u5fc3\u75c5\u7684\u4e8c\u7ea7\u9884\u9632\u836f\u7269\u6cbb\u7597\uff0c\u9664\u975e\u6709\u65e0\u7981\u5fcc\uff0c\u5426\u5219\u4e0d\u5e94\u66f4\u6539\u57fa\u7840\u7528\u836f\u65b9\u6848\u3002<\/p>\n

\u6025\u6027\u80be\u635f\u4f24\uff08AKI\uff09\u662f CAP \u7684\u4e3b\u8981\u5e76\u53d1\u75c7\u4e4b\u4e00\uff0c\u7ee7\u53d1AKI \u65f6\u9884\u540e\u66f4\u5dee\u3002\u7814\u7a76\u53d1\u73b0\uff0c\u5e74\u9f84\u3001\u6162\u6027\u80be\u75c5\u53f2\u3001\u610f\u8bc6\u969c\u788d\u3001\u767d\u86cb\u767d <30 g\/L \u548c\u4e73\u9178 >2 mmol\/L \u7b49\u5371\u9669\u56e0\u7d20\u6709\u52a9\u4e8e\u65e9\u671f\u8bc6\u522b CAP \u60a3\u8005\u53d1\u751f AKI \u7684\u98ce\u9669\u3002\u5728\u6cbb\u7597\u4e2d\u5e94\u614e\u7528\u80be\u6bd2\u6027\u836f\u7269\uff0c\u5e76\u6839\u636e\u836f\u7269\u7684\u836f\u6548\u5b66\u3001\u836f\u4ee3\u52a8\u529b\u5b66\u548c\u808c\u9150\u6e05\u9664\u7387\u7b49\u8c03\u6574\u836f\u7269\u5242\u91cf\u548c\u7ed9\u836f\u9891\u7387\uff0c\u51cf\u5c11 AKI \u7684\u53d1\u751f\u3002\u5bf9\u4e8e\u5df2\u7ecf\u5408\u5e76 AKI \u7684 CAP \u6cbb\u7597\uff0c\u5e94\u7ef4\u6301\u6b63\u5e38\u7684\u8840\u5bb9\u91cf\u3001\u4fdd\u6301\u8840\u6d41\u52a8\u529b\u5b66\u7a33\u5b9a\u3001\u907f\u514d\u7f3a\u6c27\uff0c\u5fc5\u8981\u65f6\u7ed9\u4e88\u80be\u810f\u66ff\u4ee3\u6cbb\u7597\u3002<\/p>\n

\u6025\u6027\u80c3\u80a0\u9053\u635f\u4f24\u5e38\u89c1\u4e8e\u91cd\u75c7 CAP \u60a3\u8005\u3002\u5728\u6cbb\u7597\u539f\u53d1\u75c5\u548c\u7ea0\u6b63\u7f3a\u6c27\u7684\u540c\u65f6\uff0c\u5e94\u5c3d\u65e9\u542f\u52a8\u80a0\u5185\u8425\u517b\uff0c\u5e76\u51cf\u5c11\u89e3\u70ed\u9547\u75db\u836f\u7269\u7684\u4f7f\u7528\u3002\u5bf9\u4e8e\u975e\u9ad8\u5371\u60a3\u8005\uff0c\u4e0d\u63a8\u8350\u5e38\u89c4\u4f7f\u7528\u6291\u9178\u836f\u7269\u9884\u9632\u6d88\u5316\u9053\u51fa\u8840\u3002\u8d28\u5b50\u6cf5\u6291\u5236\u5242\u7684\u4f7f\u7528\u5e76\u4e0d\u80fd\u663e\u8457\u964d\u4f4e\u6d88\u5316\u9053\u51fa\u8840\u7684\u98ce\u9669\uff0c\u53cd\u800c\u53ef\u80fd\u589e\u52a0\u9662\u5185\u83b7\u5f97\u6027\u80ba\u708e\u7684\u98ce\u9669\u3002<\/p>\n

\u6025\u6027\u809d\u635f\u4f24\u662f CAP \u5e38\u89c1\u5e76\u53d1\u75c7\u4e4b\u4e00\uff0c\u76ee\u524d\u8ba4\u4e3a\u8f7b\u5ea6\u7684\u809d\u635f\u4f24\u5728 CAP \u4e2d\u8f83\u4e3a\u666e\u904d\uff0c\u901a\u5e38\u4e0d\u5f71\u54cd\u9884\u540e\u3002\u5bf9\u4e8e\u4e25\u91cd\u6025\u6027\u809d\u635f\u4f24\uff0c\u5e94\u79ef\u6781\u5bfb\u627e\u6f5c\u5728\u75c5\u56e0\uff0c\u5305\u62ec\u65e2\u5f80\u809d\u75c5\u53f2\u3001\u809d\u6bd2\u6027\u836f\u7269\u7684\u66b4\u9732\u3001\u7f3a\u6c27\u548c\u5faa\u73af\u72b6\u51b5\u7b49\u56e0\u7d20\uff0c\u5e76\u5bc6\u5207\u76d1\u6d4b\u751f\u5316\u6307\u6807\uff0c\u8b66\u60d5\u809d\u8870\u7aed\u7684\u53d1\u751f\u3002\u5bf9\u4e8e\u7f3a\u6c27\u578b\u809d\u635f\u4f24\u5e94\u52a0\u5f3a\u547c\u5438\u3001\u5faa\u73af\u652f\u6301\uff1b\u5bf9\u4e8e\u7591\u4f3c\u836f\u7269\u6027\u809d\u635f\u4f24\u7684\u60a3\u8005\uff0c\u5e94\u8003\u8651\u505c\u7528\u6216\u51cf\u91cf\u53ef\u7591\u836f\u7269\u3002<\/p>\n

\u63a8\u8350\u610f\u89c1 19 \uff1a<\/b> \u91cd\u75c7 <\/b>CAP <\/b>\u60a3\u8005\u6613\u5e76\u53d1\u591a\u810f\u5668\u529f\u80fd\u969c\u788d\uff0c\u5305\u62ec\u8113\u6bd2\u6027\u4f11\u514b\u3001\u8113\u6bd2\u75c7\u5fc3\u808c\u75c5\u3001\u6025\u6027\u80be\u635f\u4f24\u3001\u6025\u6027\u80c3\u80a0\u9053\u635f\u4f24\u53ca\u6025\u6027\u809d\u635f\u4f24\u7b49\uff0c\u5e94\u52a8\u6001\u8bc4\u4f30\u5668\u5b98\u529f\u80fd\uff0c\u53ca\u65f6\u5e72\u9884\uff0c\u4ee5\u63d0\u9ad8 <\/b>CAP <\/b>\u7684\u6cbb\u7597\u6210\u529f\u7387\uff08\u8bc1\u636e\u7b49\u7ea7\u2162\uff0c\u63a8\u8350\u7b49\u7ea7 <\/b>B<\/b>\uff09\u3002<\/b><\/b><\/p>\n

9 \u6210\u4eba CAP \u6cbb\u7597\u540e\u8bc4\u4f30\u5185\u5bb9\u4e0e\u5904\u7406<\/b><\/b><\/p>\n

9.1 \u6cbb\u7597\u540e\u8bc4\u4f30\u5185\u5bb9<\/p>\n

72 h \u88ab\u8ba4\u4e3a\u662f CAP \u60a3\u8005\u8fbe\u5230\u4e34\u5e8a\u7a33\u5b9a\u6240\u9700\u7684\u4e2d\u4f4d\u65f6\u95f4\uff0c\u4e5f\u662f\u6c14\u9053\u7ec6\u83cc\u6d53\u5ea6\u4e0b\u964d\u3001\u83b7\u53d6\u76f8\u5173\u6807\u672c\u6216\u8fdb\u884c\u5185\u955c\u68c0\u67e5\u7684\u5408\u7406\u65f6\u95f4\u7a97\u53e3\uff0c\u56e0\u6b64\u5efa\u8bae\u521d\u59cb\u7ecf\u9a8c\u6027\u6cbb\u7597 72 h \u540e\u5bf9\u6025\u8bca CAP\u60a3\u8005\u8fdb\u884c\u75c5\u60c5\u8bc4\u4f30\u3002\u5728\u91cd\u75c7 CAP \u7684\u6cbb\u7597\u8fc7\u7a0b\u4e2d\uff0c\u5e94\u52a0\u5f3a\u75c5\u60c5\u8bc4\u4f30\u548c\u5bc6\u5207\u76d1\u6d4b\u3002\u8bc4\u4f30\u5185\u5bb9\u5e94\u5305\u62ec\u4ee5\u4e0b\u51e0\u4e2a\u65b9\u9762\uff1a<\/p>\n

9.1.1 \u4e34\u5e8a\u60c5\u51b5<\/p>\n

\u5bf9\u4e8e\u6cbb\u7597\u540e\u4f53\u6e29\u548c\u547c\u5438\u9891\u7387\u6301\u7eed\u6539\u5584\uff0c\u5fc3\u7387\u3001\u8840\u538b\u53ca\u8109\u6c27\u9971\u548c\u5ea6\u7a33\u5b9a\u7684\u60a3\u8005\uff0c\u53ef\u7ee7\u7eed\u5f53\u524d\u7684\u6297\u611f\u67d3\u65b9\u6848\u3002\u5bf9\u4e8e\u4e34\u5e8a\u7a33\u5b9a\u4e14\u80fd\u8010\u53d7\u53e3\u670d\u836f\u7269\u6cbb\u7597\u7684\u60a3\u8005\u53ef\u6539\u7528\u540c\u7c7b\u6216\u6297\u83cc\u8c31\u76f8\u8fd1\u4e14\u5bf9\u81f4\u75c5\u83cc\u654f\u611f\u7684\u53e3\u670d\u836f\u7269\u8fdb\u884c\u5e8f\u8d2f\u6cbb\u7597\u3002\u7559\u89c2\u60a3\u8005\u5728\u5e8f\u8d2f\u6cbb\u7597\u5f53\u5929\u53ef\u4e88\u4ee5\u79bb\u9662\u3002<\/p>\n

9.1.2 \u5b9e\u9a8c\u5ba4\u68c0\u67e5<\/p>\n

\u4f4f\u9662\u60a3\u8005\u5efa\u8bae 72 h \u540e\u590d\u67e5\u8840\u5e38\u89c4\u3001 CRP \u548c PCT\uff0c\u5fc5\u8981\u65f6\u590d\u67e5\u8840\u6c14\u5206\u6790\u3002\u91cd\u75c7\u60a3\u8005\u52a8\u6001\u76d1\u6d4b\u708e\u75c7\u6807\u5fd7\u7269\u3001\u8840\u6c14\u5206\u6790\u53ca\u5668\u5b98\u529f\u80fd\u7b49\u3002<\/p>\n

9.1.3 \u75c5\u539f\u5b66\u68c0\u67e5<\/p>\n

\u53ef\u590d\u67e5\u5e38\u89c4\u5fae\u751f\u7269\u5b66\u68c0\u67e5\u5982\u75f0\u6d82\u7247\u53ca\u57f9\u517b\u7b49\uff0c\u5fc5\u8981\u65f6\u53ef\u8fdb\u884c\u5206\u5b50\u751f\u7269\u5b66\u68c0\u6d4b\u5982\u75c5\u539f\u4f53\u6838\u9178\u3001\u75f0\u6216\u80ba\u6ce1\u704c\u6d17\u6db2NGS \u7b49\uff0c\u6216\u8840\u6e05\u5b66\u5982\u7279\u5f02\u6027\u6297\u539f \/ \u6297\u4f53\u7b49\u3002<\/p>\n

9.1.4 \u80f8\u90e8\u5f71\u50cf\u5b66<\/p>\n

\u4e34\u5e8a\u75c7\u72b6\u663e\u8457\u6539\u5584\u7684\u60a3\u8005\u4e0d\u63a8\u8350\u5e38\u89c4\u590d\u67e5\u80f8\u90e8\u5f71\u50cf\u5b66\u3002\u5bf9\u4e8e\u75c7\u72b6\u6216\u4f53\u5f81\u6301\u7eed\u5b58\u5728\u6216\u6076\u5316\u7684\u60a3\u8005\uff0c\u5e94\u590d\u67e5\u80f8\u90e8 CT\u6216 X \u7ebf\u80f8\u7247\u3002\u5e8a\u65c1\u8d85\u58f0\u5728\u80ba\u708e\u8bca\u65ad\u4e2d\u7684\u5e94\u7528\u65e5\u76ca\u5e7f\u6cdb\uff0c\u5177\u6709\u4fbf\u6377\u3001\u65e0\u521b\u3001\u53ef\u91cd\u590d\u3001\u6613\u5b9a\u6027\u3001\u4e0e\u80f8\u90e8 CT \u4e00\u81f4\u6027\u597d\u7b49\u7279\u70b9\uff0c\u5efa\u8bae\u6709\u6761\u4ef6\u7684\u5355\u4f4d\u79ef\u6781\u5f00\u5c55\uff0c\u7279\u522b\u662f\u5bf9\u75c5\u60c5\u5371\u91cd\u3001\u642c\u52a8\u4e0d\u4fbf\u7684\u60a3\u8005\u3002<\/p>\n

9.2 \u6cbb\u7597\u5931\u8d25\u7684\u5206\u6790\u4e0e\u5904\u7406<\/p>\n

\u6cbb\u7597\u5931\u8d25\u662f\u6307\u60a3\u8005\u5bf9\u6297\u611f\u67d3\u6cbb\u7597\u7f3a\u4e4f\u4e34\u5e8a\u53cd\u5e94\uff0c\u6216\u4e34\u5e8a\u53cd\u5e94\u4e0d\u8db3\u3002\u4e3b\u8981\u5305\u62ec\u4e09\u79cd\u5f62\u5f0f \uff1a\u2474\u65e9\u671f\u6cbb\u7597\u5931\u8d25\uff0c\u5373\u5165\u9662 72 h \u5185\u75c5\u60c5\u6076\u5316\uff0c\u8fdb\u5c55\u81f3\u6025\u6027\u547c\u5438\u8870\u7aed\u9700\u673a\u68b0\u901a\u6c14\u6216\u53d1\u5c55\u4e3a\u8113\u6bd2\u6027\u4f11\u514b \uff1b\u2475\u60a3\u8005\u53d1\u70ed\u548c\u5176\u4ed6\u4e34\u5e8a\u75c7\u72b6\u6301\u7eed\u5b58\u5728\uff0c\u672a\u8fbe\u5230\u4e34\u5e8a\u7a33\u5b9a\uff1b\u2476\u6cbb\u7597 72 h \u540e\u51fa\u73b0\u8fdb\u5c55\u6027\u80ba\u708e\uff0c\u4f34\u6709\u4e34\u5e8a\u6076\u5316\u3001\u547c\u5438\u8870\u7aed\u6216\u4f11\u514b\u3002\u6cbb\u7597\u5931\u8d25\u7684\u53d1\u751f\u7387\u56e0\u5b9a\u4e49\u5dee\u5f02\u800c\u5f02\u3002\u6211\u56fd\u591a\u9879\u7814\u7a76\u663e\u793a CAP \u60a3\u8005\u6cbb\u7597\u5931\u8d25\u7387\u4e3a11%~26.3%\u3002\u6cbb\u7597\u5931\u8d25\u4f1a\u5bfc\u81f4\u60a3\u8005\u4f4f\u9662\u65f6\u95f4\u5ef6\u957f\u3001\u589e\u52a0\u4f4f\u9662\u8d39\u7528\u53ca\u75c5\u6b7b\u7387\u3002<\/p>\n

\u5bf9\u4e8e\u6cbb\u7597\u5931\u8d25\u7684\u60a3\u8005\uff0c\u5e94\u91cd\u65b0\u8bc4\u4f30\u5176\u5371\u9669\u56e0\u7d20\u3001\u4e34\u5e8a\u75c5\u53f2\u548c\u521d\u59cb\u5fae\u751f\u7269\u5b66\u7ed3\u679c\uff0c\u4ed4\u7ec6\u4f53\u683c\u68c0\u67e5\uff0c\u5b8c\u5584\u6216\u590d\u67e5\u80f8\u90e8 CT\u3002\u540c\u65f6\uff0c\u5e94\u590d\u67e5\u5fae\u751f\u7269\u5b66\u68c0\u67e5\uff0c\u5fc5\u8981\u65f6\u8fdb\u884c PCR\u3001NGS \u7b49\u5206\u5b50\u751f\u7269\u5b66\u68c0\u67e5\u3002\u6cbb\u7597\u5931\u8d25\u7684\u5206\u6790\u548c\u5904\u7406\u53ef\u4ece\u5e76\u53d1\u75c7\u3001\u8bca\u65ad\u3001\u75c5\u539f\u3001\u5bbf\u4e3b\u53ca\u836f\u7269\u56e0\u7d20\u4e94\u4e2a\u65b9\u9762\u8fdb\u884c\uff08\u56fe 2\uff09\u3002<\/p>\n

\u63a8\u8350\u610f\u89c1 20 \uff1a<\/b> \u5efa\u8bae\u5bf9\u8f7b\u4e2d\u5ea6 <\/b>CAP <\/b>\u60a3\u8005\u6cbb\u7597 <\/b>72 h <\/b>\u540e\u8fdb\u884c\u8bc4\u4f30\uff0c\u91cd\u75c7 <\/b>CAP <\/b>\u60a3\u8005\u5e94\u53ca\u65f6\u52a8\u6001\u8bc4\u4f30\u3002\u6cbb\u7597\u5931\u8d25\u8005\u4ece\u5e76\u53d1\u75c7\u3001\u8bca\u65ad\u3001\u75c5\u539f\u3001\u5bbf\u4e3b\u53ca\u836f\u7269\u56e0\u7d20\u4e94\u4e2a\u65b9\u9762\u8fdb\u884c\u5206\u6790\u548c\u5904\u7406\u3002\uff08\u8bc1\u636e\u7b49\u7ea7\u2162\uff0c\u63a8\u8350\u7b49\u7ea7 <\/b>B<\/b>\uff09<\/b><\/b><\/p>\n

9.3 \u6210\u4eba CAP \u51fa\u9662\u6807\u51c6<\/p>\n

\u63a8\u8350\u610f\u89c1 21 \uff1a <\/b>CAP <\/b>\u60a3\u8005\u8bca\u65ad\u660e\u786e\uff0c\u7ecf\u6cbb\u7597\u75c5\u60c5\u660e\u663e\u597d\u8f6c\uff0c\u4f53\u6e29\u6b63\u5e38\u6301\u7eed\u8d85\u8fc7 <\/b>24 h <\/b>\u4e14\u6ee1\u8db3\u4e0b\u5217\u4e34\u5e8a\u7a33\u5b9a\u56db\u9879\u6807\u51c6\uff1a\u2460\u5fc3\u7387<\/b>\u2264 <\/b>100 <\/b>\u6b21 <\/b>\/min <\/b>\uff1b\u2461\u547c\u5438\u9891\u7387<\/b>\u2264 <\/b>24 <\/b>\u6b21 <\/b>\/min <\/b>\uff1b\u2462\u6536\u7f29\u538b<\/b>\u2265 <\/b>90 mmHg <\/b>\uff1b\u2463\u5438\u7a7a\u6c14\u65f6\u8840\u6c27\u9971\u548c\u5ea6<\/b>\u2265 <\/b>90% <\/b>\u6216\u8005\u52a8\u8109\u6c27\u5206\u538b<\/b>\u2265 <\/b>60 mmHg<\/b>\u3002\u53ef\u4ee5\u8f6c\u4e3a\u53e3\u670d\u836f\u7269\u6cbb\u7597\uff0c\u65e0\u5e76\u53d1\u75c7\u9700\u8fdb\u4e00\u6b65\u5904\u7406\uff0c\u53ef\u4ee5\u7ed9\u4e88\u51fa\u9662\u3002<\/b><\/b><\/p>\n

10 \u7279\u6b8a\u7c7b\u578b CAP<\/b><\/b><\/p>\n

10.1\u3000\u75c5\u6bd2\u6027\u80ba\u708e<\/p>\n

\u6210\u4eba\u75c5\u6bd2\u6027\u80ba\u708e\u7684\u7279\u5f81\u5305\u62ec \uff1a\u2474\u591a\u6570\u5177\u6709\u5b63\u8282\u6027\uff0c\u53ef\u6709\u6d41\u884c\u75c5\u5b66\u63a5\u89e6\u53f2\u6216\u7fa4\u805a\u6027\u53d1\u75c5\uff1b\u2475\u8001\u5e74\u4eba\u548c\u514d\u75ab\u529f\u80fd\u4f4e\u4e0b\u8005\u662f\u9ad8\u5371\u4eba\u7fa4\uff1b\u2476\u53d1\u75c5\u521d\u671f\u53ef\u6709\u4e0a\u547c\u5438\u9053\u75c7\u72b6\u3001\u808c\u75db\u7b49\uff1b \u2477\u5916\u5468\u8840\u767d\u7ec6\u80de\u8ba1\u6570\u53ef\u80fd\u6b63\u5e38\u6216\u51cf\u4f4e\uff0c\u964d\u9499\u7d20\u539f\u901a\u5e38\u5904\u4e8e\u6b63\u5e38\u6c34\u5e73\uff1b\u2478\u6297\u83cc\u836f\u7269\u6cbb\u7597\u65e0\u6548\uff1b\u2479\u80f8\u90e8 CT \u8868\u73b0\u4e3a\u53cc\u4fa7\u3001\u591a\u53f6\u95f4\u8d28\u6027\u6e17\u51fa\u3001\u78e8\u73bb\u7483\u5f71\uff0c\u53ef\u4f34\u6709\u5b9e\u53d8\u3002\u817a\u75c5\u6bd2\u80ba\u708e\u662f\u4e00\u79cd\u7279\u6b8a\u7c7b\u578b\u75c5\u6bd2\u6027\u80ba\u708e\uff0c\u5360\u6211\u56fd CAP \u7684 2.94%\uff0c\u53ef\u7d2f\u53ca\u514d\u75ab\u529f\u80fd\u6b63\u5e38\u6210\u4eba\uff0c\u5c24\u5176\u5728\u805a\u96c6\u4eba\u7fa4\u4e2d\u9ad8\u53d1\uff0c\u4ee5\u4e2d\u9752\u5e74\u7537\u6027\u591a\u89c1\u3002\u5c11\u6570\u60a3\u8005\u8fc5\u901f\u8fdb\u5c55\u81f3\u91cd\u75c7\u80ba\u708e\uff0c\u603b\u4f53\u75c5\u6b7b\u7387\u4e3a0.3%\u3002<\/p>\n

\u5bf9\u4e8e\u7591\u4f3c\u75c5\u6bd2\u6027 CAP \u8005\uff0c\u5e94\u5c3d\u65e9\u8fdb\u884c\u75c5\u6bd2\u5206\u5b50\u751f\u7269\u5b66\u6216\u6297\u539f\u6297\u4f53\u68c0\u6d4b\uff0c\u63a8\u8350\u4f18\u5148\u9009\u62e9\u591a\u91cd PCR \u6280\u672f\uff0c\u5fc5\u8981\u65f6\u8fdb\u884c NGS \u68c0\u6d4b\u3002\u75c5\u6bd2\u6027 CAP \u9700\u8b66\u60d5\u7ee7\u53d1\u7ec6\u83cc\u611f\u67d3\u53ef\u80fd\uff0c\u6709\u7ec6\u83cc\u611f\u67d3\u8bc1\u636e\u65f6\u53ca\u65f6\u4f7f\u7528\u6297\u83cc\u836f\u7269\u3002\u6d41\u611f\u75c5\u6bd2\u68c0\u6d4b\u9633\u6027\u7684\u91cd\u75c7 CAP\uff0c\u7ecf\u9a8c\u6027\u6cbb\u7597\u5efa\u8bae\u8986\u76d6\u91d1\u9ec4\u8272\u8461\u8404\u7403\u83cc\u3001\u80ba\u708e\u94fe\u7403\u83cc\u53ca\u6d41\u611f\u55dc\u8840\u6746\u83cc\u3002<\/p>\n

10.2\u3000\u652f\u539f\u4f53\u80ba\u708e<\/p>\n

\u80ba\u708e\u652f\u539f\u4f53\u80ba\u708e\u5728\u65e0\u57fa\u7840\u75be\u75c5\u7684\u9752\u58ee\u5e74 CAP \u60a3\u8005\u4e2d\u6240\u5360\u6bd4\u4f8b\u8f83\u9ad8\uff0c\u79cb\u51ac\u4e3a\u9ad8\u53d1\u5b63\u8282\uff0c\u6f5c\u4f0f\u671f\u4e3a 1~3 \u5468\u3002\u591a\u6570\u60a3\u8005\u4ec5\u4f4e\u70ed\u548c\u75b2\u4e4f\uff0c\u90e8\u5206\u60a3\u8005\u53ef\u7a81\u53d1\u9ad8\u70ed\u5e76\u4f34\u6709\u660e\u663e\u7684\u5934\u75db\u3001\u808c\u75db\u3001\u6076\u5fc3\u7b49\u75c7\u72b6\u3002\u547c\u5438\u9053\u75c7\u72b6\u4ee5\u5e72\u54b3\u6700\u4e3a\u7a81\u51fa\uff0c\u53ef\u6301\u7eed\uff14\u5468\u4ee5\u4e0a\uff0c\u591a\u4f34\u6709\u660e\u663e\u7684\u54bd\u75db\u3002\u6781\u5c11\u6570\u60a3\u8005\u53ef\u4f34\u53d1\u80c3\u80a0\u708e\u3001\u5fc3\u5305\u708e\u3001\u5fc3\u808c\u708e\u3001\u8111\u819c\u8111\u708e\u7b49\u3002\u80ba\u90e8\u5f02\u5e38\u4f53\u5f81\u591a\u4e0d\u660e\u663e\uff0c\u5c11\u6570\u60a3\u8005\u53ef\u95fb\u53ca\u5e72\u6e7f\u6027\u5570\u97f3\u3002\u60a3\u8005\u5916\u5468\u8840\u767d\u7ec6\u80de\u603b\u6570\u548c\u4e2d\u6027\u7c92\u7ec6\u80de\u6bd4\u4f8b\u4e00\u822c\u6b63\u5e38\uff0c\u5c11\u6570\u60a3\u8005\u53ef\u5347\u9ad8\uff0c CRP \u53ef\u660e\u663e\u5347\u9ad8\uff0c PCT \u5e38\u6b63\u5e38\u3002\u80ba\u90e8\u9633\u6027\u4f53\u5f81\u5c11\u800c\u5f71\u50cf\u5b66\u8868\u73b0\u660e\u663e\u662f\u652f\u539f\u4f53\u80ba\u708e\u7684\u91cd\u8981\u7279\u70b9\uff0c\u5178\u578b CT \u8868\u73b0\u8be6\u89c1\u8868 9\uff0c\u91cd\u75c7\u53ef\u5408\u5e76\u80f8\u8154\u79ef\u6db2\u3002<\/p>\n

\u652f\u539f\u4f53\u6838\u9178\u68c0\u6d4b\u7075\u654f\u5ea6\u548c\u7279\u5f02\u5ea6\u5747\u9ad8\uff0c\u53ef\u4f5c\u4e3a\u9996\u9009\u7684\u68c0\u6d4b\u624b\u6bb5\u3002\u652f\u539f\u4f53 IgM \u6297\u4f53\u4e00\u822c\u5728\u611f\u67d3\u540e 4~5 d \u51fa\u73b0\uff0c\u4e5f\u53ef\u4f5c\u4e3a\u65e9\u671f\u611f\u67d3\u7684\u8bca\u65ad\u6307\u6807\u3002\u80ba\u708e\u652f\u539f\u4f53\u5bf9\u5927\u73af\u5185\u916f\u7c7b\u6297\u83cc\u836f\u7269\u5177\u6709\u5f88\u9ad8\u7684\u8010\u836f\u7387\uff0c\u786e\u8bca\u652f\u539f\u4f53\u80ba\u708e\u7684\u6210\u4eba\u60a3\u8005\u9996\u9009\u56db\u73af\u7d20\u7c7b\u6216\u55b9\u8bfa\u916e\u7c7b\u836f\u7269\u3002<\/p>\n

10.3 \u9e66\u9e49\u70ed\u8863\u539f\u4f53\u80ba\u708e<\/p>\n

\u9e66\u9e49\u70ed\u8863\u539f\u4f53\u7ea6\u5360 CAP \u75c5\u539f\u4f53 1.03%\uff0c\u5c5e\u4e8e\u76f8\u5bf9\u5c11\u89c1\u7684\u75c5\u539f\u4f53 , \u4f46\u53ef\u5bfc\u81f4\u91cd\u75c7 CAP\u3002\u968f\u7740\u75c5\u539f\u68c0\u6d4b\u6280\u672f\u7684\u53d1\u5c55\uff0c\u6211\u56fd\u786e\u8bca\u7684\u9e66\u9e49\u70ed\u8863\u539f\u4f53 CAP \u75c5\u4f8b\u5448\u4e0a\u5347\u8d8b\u52bf\u3002\u56fd\u5185\u4e00\u9879\u591a\u4e2d\u5fc3\u524d\u77bb\u6027\u7814\u7a76\u663e\u793a\uff0c\u5728\u514d\u75ab\u529f\u80fd\u6b63\u5e38\u7684\u91cd\u75c7 CAP\u60a3\u8005\u4e2d\uff0c\u9e66\u9e49\u70ed\u8863\u539f\u4f53\u7684\u5206\u79bb\u7387\u4e3a 8.0%\u3002\u7814\u7a76\u53d1\u73b0\uff0c41.9%~62.5% \u7684\u60a3\u8005\u6709\u660e\u786e\u7684\u79bd\u7c7b\u63a5\u89e6\u53f2\uff0c\u5982\u9972\u517b\u9e66\u9e49\u6216\u9e3d\u5b50\u3001\u63a5\u89e6\u6d3b\u79bd\u7b49\uff0c\u4e3b\u8981\u5728\u51ac\u3001\u6625\u5b63\u53d1\u75c5\u3002\u4e34\u5e8a\u8868\u73b0\u5305\u62ec\u53d1\u70ed\u3001\u76f8\u5bf9\u7f13\u8109\uff0c\u90e8\u5206\u60a3\u8005\u4f34\u6709\u54b3\u55fd\u3001\u54b3\u75f0\u3001\u5934\u75db\u3001\u8c35\u5984\u3001\u808c\u8089\u9178\u75db\u548c\u6d88\u5316\u9053\u75c7\u72b6\u3002\u7ea6\u4e09\u5206\u4e4b\u4e00\u7684\u60a3\u8005\u5e76\u53d1\u6025\u6027\u547c\u5438\u8870\u7aed\u3002\u8840\u767d\u7ec6\u80de\u5927\u591a\u6b63\u5e38\uff0c\u4e2d\u6027\u7c92\u7ec6\u80de\u5e38\u5347\u9ad8\uff0c\u6dcb\u5df4\u7ec6\u80de\u964d\u4f4e\u3002 CRP \u548c\u94c1\u86cb\u767d\u5e38\u660e\u663e\u5347\u9ad8\uff0c\u800c PCT \u591a\u6b63\u5e38\u6216\u8f7b\u5ea6\u5347\u9ad8\uff0c\u5371\u91cd\u75c7\u60a3\u8005 PCT \u53ef\u663e\u8457\u5347\u9ad8\u3002\u80f8\u90e8 CT \u4e3b\u8981\u8868\u73b0\u4e3a\u5b9e\u53d8\u5f71\uff0c\u90e8\u5206\u4e3a\u78e8\u73bb\u7483\u5f71\u6837\u6e17\u51fa\uff0c\u53ef\u5408\u5e76\u80f8\u8154\u79ef\u6db2\uff0c\u591a\u4e3a\u5355\u4fa7\u5c11\u91cf\u80f8\u8154\u79ef\u6db2\uff0c 90.7\uff05\u7684\u60a3\u8005\u80ba\u90e8\u75c5\u7076\u5c40\u9650\u4e8e\u5355\u4fa7\u80ba\u3002<\/p>\n

\u76ee\u524d\u4e34\u5e8a\u9e66\u9e49\u70ed\u8863\u539f\u4f53\u75c5\u539f\u5b66\u68c0\u6d4b\u4e3b\u8981\u4f9d\u9760\u5206\u5b50\u751f\u7269\u5b66\u68c0\u6d4b\u6280\u672f\uff0c\u5305\u62ec\u591a\u91cd PCR \u548c NGS \u68c0\u6d4b\u7b49\u3002\u6cbb\u7597\u9996\u9009\u56db\u73af\u7d20\u7c7b\u836f\u7269\uff0c\u91cd\u75c7\u60a3\u8005\u53ef\u8054\u5408\u5927\u73af\u5185\u916f\u7c7b\u6216\u55b9\u8bfa\u916e\u7c7b\u836f\u7269\u3002<\/p>\n

10.4\u3000\u55dc\u80ba\u519b\u56e2\u83cc\u80ba\u708e<\/p>\n

\u55dc\u80ba\u519b\u56e2\u83cc\u80ba\u708e\u7ea6\u5360 CAP \u7684 1%\u3002\u519b\u56e2\u83cc\u5e7f\u6cdb\u5b58\u5728\u4e8e\u6c34\u751f\u73af\u5883\u548c\u6c34\u5206\u914d\u7cfb\u7edf\u4e2d\uff0c\u4e3b\u8981\u901a\u8fc7\u5438\u5165\u542b\u6709\u519b\u56e2\u83cc\u7684\u6c14\u6eb6\u80f6\u4f20\u64ad\u3002\u6211\u56fd\u516c\u5171\u573a\u6240\u7a7a\u8c03\u7cfb\u7edf\u3001\u6d17\u6d74\u573a\u6240\u548c\u533b\u9662\u6c34\u6837\u4e2d\u55dc\u80ba\u519b\u56e2\u83cc\u68c0\u51fa\u7387\u5747\u8f83\u9ad8\u3002\u63a5\u89e6\u6c61\u67d3\u6c34\u6e90\uff0c\u5c24\u5176\u662f\u8001\u5e74\u4eba\u3001\u7537\u6027\uff0c\u5438\u70df\u8005\u53ca\u6709\u6162\u6027\u75be\u75c5\u6216\u514d\u75ab\u6291\u5236\u7684\u4eba\u7fa4\uff0c\u611f\u67d3\u98ce\u9669\u8f83\u9ad8\u3002\u5f53 CAP \u60a3\u8005\u51fa\u73b0\u76f8\u5bf9\u7f13\u8109\u3001\u610f\u8bc6\u969c\u788d\u3001\u8179\u6cfb\u3001\u4f11\u514b\u3001\u809d\u80be\u635f\u4f24\u3001\u4f4e\u94a0\u8840\u75c7\u4ee5\u53ca\u5bf9 \u03b2 – \u5185\u9170\u80fa\u7c7b\u6297\u83cc\u836f\u7269\u65e0\u5e94\u7b54\u65f6\uff0c\u9700\u8003\u8651\u5230\u55dc\u80ba\u519b\u56e2\u83cc\u80ba\u708e\u7684\u53ef\u80fd\u3002\u80f8\u90e8\u5f71\u50cf\u76f8\u5bf9\u7279\u5f02\u6027\u7684\u8868\u73b0\u662f\u78e8\u73bb\u7483\u5f71\u4e2d\u6df7\u6742\u7740\u8fb9\u7f18\u76f8\u5bf9\u6e05\u6670\u7684\u5b9e\u53d8\u5f71\u3002\u55dc\u80ba\u519b\u56e2\u83cc\u80ba\u708e\u5e38\u53d1\u5c55\u4e3a\u91cd\u75c7\uff0c\u5728\u91cd\u75c7 CAP \u4e2d\u536012.6%\uff0c\u5408\u5e76\u6025\u6027\u547c\u5438\u8870\u7aed\u7684\u75c5\u6b7b\u7387\u8fbe 29.4%\u3002\u5bf9\u4e8e\u514d\u75ab\u529f\u80fd\u6b63\u5e38\u7684\u8f7b\u3001\u4e2d\u5ea6\u519b\u56e2\u83cc\u80ba\u708e\u60a3\u8005\uff0c\u63a8\u8350\u4f7f\u7528\u547c\u5438\u55b9\u8bfa\u916e\u7c7b\u3001\u5927\u73af\u5185\u916f\u7c7b\u6216\u56db\u73af\u7d20\u7c7b\u836f\u7269\u5355\u836f\u6cbb\u7597\u3002\u5bf9\u4e8e\u91cd\u75c7\u75c5\u4f8b\u3001\u5355\u836f\u6cbb\u7597\u5931\u8d25\u6216\u514d\u75ab\u529f\u80fd\u4f4e\u4e0b\u7684\u60a3\u8005\uff0c\u5efa\u8bae\u4f7f\u7528\u55b9\u8bfa\u916e\u7c7b\u8054\u5408\u5927\u73af\u5185\u916f\u7c7b\u836f\u7269\u6cbb\u7597\uff0c\u5e94\u8b66\u60d5\u8054\u5408\u4f7f\u7528\u9020\u6210\u7684\u4e0d\u826f\u53cd\u5e94\uff0c\u7279\u522b\u662f QT \u95f4\u671f\u5ef6\u957f\u3002<\/p>\n

\u63a8\u8350\u610f\u89c1 22 \uff1a <\/b>\u5bf9\u7591\u4f3c\u75c5\u6bd2\u6027\u80ba\u708e\u7684\u60a3\u8005\uff0c\u5e94\u5c3d\u65e9\u8fdb\u884c\u75c5\u539f\u5b66\u68c0\u6d4b\uff0c\u5e76\u8b66\u60d5\u5408\u5e76\u7ec6\u83cc\u611f\u67d3\uff0c\u91cd\u75c7\u60a3\u8005\u521d\u59cb\u6cbb\u7597\u53ef\u5e94\u7528\u6297\u83cc\u836f\u7269\u3002 <\/b>CAP <\/b>\u60a3\u8005\u7684\u75c5\u53f2\u8be2\u95ee\u5e94\u5305\u62ec\u79bd\u7c7b\u63a5\u89e6\u53f2\u3001\u65c5\u5c45\u53f2\u3001\u73af\u5883\u66b4\u9732\u53f2\u7b49\u3002\u5f53\u60a3\u8005\u51fa\u73b0\u76f8\u5bf9\u7f13\u8109\u3001\u795e\u7ecf\u7cfb\u7edf\u75c7\u72b6\u3001\u6d88\u5316\u9053\u75c7\u72b6\u3001\u809d\u80be\u635f\u4f24\u3001\u4f4e\u94a0\u8840\u75c7\u7b49\u4e34\u5e8a\u8868\u73b0\uff0c\u7ed3\u5408\u76f8\u5173\u5f71\u50cf\u5b66\u7279\u5f81\uff0c\u9700\u8003\u8651\u9e66\u9e49\u70ed\u8863\u539f\u4f53\u6216\u55dc\u80ba\u519b\u56e2\u83cc\u7b49\u611f\u67d3\u53ef\u80fd\uff08\u8bc1\u636e\u7b49\u7ea7\u2162\uff0c\u63a8\u8350\u7b49\u7ea7 <\/b>B<\/b>\uff09\u3002<\/b><\/b><\/p>\n

11 \u6210\u4eba CAP \u62a4\u7406\u4e0e\u9884\u9632<\/b><\/b><\/p>\n

11.1 \u6210\u4eba CAP \u62a4\u7406<\/p>\n

11.1.1 \u9884\u68c0\u5206\u8bca<\/p>\n

\u9884\u68c0\u5206\u8bca\u65f6\u5e94\u5feb\u901f\u76d1\u6d4b\u751f\u547d\u4f53\u5f81\uff0c\u9664\u53ef\u4f7f\u7528 NEWS \u8bc4\u5206\u8fdb\u884c\u5371\u9669\u5206\u5c42\uff0c\u8fd8\u53ef\u7ed3\u5408\u4f4e\u6c27\u8840\u75c7\u6307\u6570\uff08HI=SPO2\/RR\uff09\u5feb\u901f\u5224\u65ad\u7f3a\u6c27\u7684\u4e25\u91cd\u7a0b\u5ea6\uff0c HI<1.3 \u63d0\u793a\u75c5\u60c5\u5371\u91cd\u3002<\/p>\n

11.1.2 \u75c7\u72b6\u62a4\u7406<\/p>\n

\u52a8\u6001\u76d1\u6d4b\u60a3\u8005\u4f53\u6e29\uff0c\u5f53\u51fa\u73b0\u4f53\u6e29\u226538.5\u2103\u65f6\u63a8\u8350\u4f7f\u7528\u6e29\u6c34\u64e6\u6d74\u3001\u5927\u8840\u7ba1\u7ecf\u8fc7\u5904\uff08\u5934\u90e8\u3001\u814b\u7a9d\u3001\u8179\u80a1\u6c9f\u7b49\uff09\u7ed9\u4e88\u51b0\u6577\u7b49\u7269\u7406\u964d\u6e29\u3002\u6548\u679c\u4e0d\u663e\u65f6\u53ef\u7ed9\u4e88\u836f\u7269\u964d\u6e29\uff0c\u7ed9\u836f\u9014\u5f84\u5305\u62ec\u53e3\u670d\u3001\u5916\u7528\uff08\u76f4\u80a0\u7ed9\u836f\uff09\u53ca\u9759\u8109\u4f7f\u7528\u9000\u70ed\u836f\u3002\u9000\u70ed\u5904\u7406\u540e\u6ce8\u610f\u89c2\u5bdf\u60a3\u8005\u4f53\u6e29\u3001\u8109\u640f\u3001\u8840\u538b\u53ca\u6c57\u51fa\u7684\u60c5\u51b5\uff0c\u4fdd\u6301\u6c34\u7535\u89e3\u8d28\u5e73\u8861 \uff1b\u5631\u60a3\u8005\u76d6\u88ab\u9759\u5367\uff0c\u53ca\u65f6\u66f4\u6362\u6c57\u6e7f\u8863\u88ab\u3002<\/p>\n

11.1.3 \u7528\u836f\u62a4\u7406<\/p>\n

\u62a4\u7406\u4eba\u5458\u8fdb\u884c\u836f\u7269\u6cbb\u7597\u65f6\uff0c\u9700\u6ce8\u610f\u836f\u7269\u6d53\u5ea6\u3001\u914d\u4f0d\u7981\u5fcc\u3001\u7528\u836f\u95f4\u9694\u65f6\u95f4\u3001\u836f\u7269\u7684\u7597\u6548\u548c\u4e0d\u826f\u53cd\u5e94\u7b49\u3002\u4e25\u683c\u63a7\u5236\u8f93\u6db2\u901f\u5ea6\uff0c\u9884\u9632\u6025\u6027\u5de6\u5fc3\u8870\u7b49\u8f93\u6db2\u76f8\u5173\u5e76\u53d1\u75c7\u7684\u53d1\u751f\u3002<\/p>\n

11.1.4 \u996e\u98df\u62a4\u7406<\/p>\n

\u6839\u636e\u60a3\u8005\u75c5\u60c5\u5236\u5b9a\u4e2a\u6027\u5316\u996e\u98df\u65b9\u6848\uff0c\u52a8\u6001\u8bc4\u4f30\u60a3\u8005\u8425\u517b\u72b6\u6001\uff0c\u505a\u597d\u996e\u98df\u62a4\u7406\u3002\u9f3b\u9972\u8425\u517b\u8005\uff0c\u9700\u5173\u6ce8\u80c3\u80a0\u9053\u8010\u53d7\u6027\uff0c\u5582\u517b\u70ed\u91cf\u548c\u86cb\u767d\u8d28\u7684\u8fbe\u6807\u7b49\u3002<\/p>\n

11.1.5 \u5fc3\u7406\u62a4\u7406<\/p>\n

\u5e94\u91cd\u89c6\u60a3\u8005\u5fc3\u7406\u95ee\u9898\uff0c\u5efa\u7acb\u826f\u597d\u7684\u62a4\u60a3\u5173\u7cfb\uff0c\u505a\u597d\u5fc3\u7406\u62a4\u7406\uff0c\u6d88\u9664\u60a3\u8005\u7126\u8651\u3001\u6050\u60e7\u7b49\u60c5\u7eea\uff0c\u4fc3\u8fdb\u60a3\u8005\u5eb7\u590d\u3002\u91cd\u75c7\u60a3\u8005\u9700\u6ce8\u610f\u8c35\u5984\u7684\u9884\u9632\u548c\u5904\u7406\u3002<\/p>\n

11.1.6 \u5eb7\u590d\u62a4\u7406<\/p>\n

\u6839\u636e\u60a3\u8005\u75c5\u60c5\u5236\u5b9a\u4e2a\u6027\u5316\u65e9\u671f\u5eb7\u590d\u953b\u70bc\uff0c\u51cf\u5c11\u5e76\u53d1\u75c7\u3002\u8f7b\u75c7\u8005\u63a8\u8350\u91c7\u53d6\u65e9\u671f\u5eb7\u590d\u953b\u70bc\u63aa\u65bd\uff0c\u5305\u62ec\u6709\u6c27\u8bad\u7ec3\u3001\u808c\u529b\u8bad\u7ec3\u3001\u547c\u5438\u808c\u8bad\u7ec3\u3001\u5e73\u8861\u8bad\u7ec3\u3001\u6062\u590d\u65e5\u5e38\u751f\u6d3b\u548c\u5de5\u4f5c\u7684\u529f\u80fd\u6027\u8bad\u7ec3\u7b49\u3002\u91cd\u75c7 CAP \u60a3\u8005\u5728 ICU \u671f\u95f4\u7684\u5eb7\u590d\u5305\u62ec\u4f7f\u7528\u4e00\u822c\u9884\u9632\u7b56\u7565\u3001\u65e9\u671f\u8fd0\u52a8\u953b\u70bc\u3001\u5fc3\u7406\u5e72\u9884\u7b49\u63aa\u65bd\u3002\u6761\u4ef6\u5141\u8bb8\u65f6\u53ef\u8054\u7cfb\u5eb7\u590d\u533b\u5b66\u79d1\u9488\u5bf9\u6027\u5eb7\u590d\u6cbb\u7597\u3002<\/p>\n

\u63a8\u8350\u610f\u89c1 23\uff1a <\/b>\u62a4\u7406\u4eba\u5458\u5728\u9884\u68c0\u5206\u8bca\u3001\u75c7\u72b6\u3001\u7528\u836f\u3001\u996e\u98df\u3001\u5fc3\u7406\u53ca\u5eb7\u590d\u7b49\u65b9\u9762\u79ef\u6781\u53c2\u4e0e\uff0c\u6709\u5229\u4e8e\u4fc3\u8fdb <\/b>CAP <\/b>\u60a3\u8005\u7684\u6062\u590d\uff08\u8bc1\u636e\u7b49\u7ea7\u2162\uff0c\u63a8\u8350\u7b49\u7ea7 <\/b>A<\/b>\uff09\u3002<\/b><\/b><\/p>\n

11.2 \u6210\u4eba CAP \u9884\u9632<\/b><\/p>\n

11.2.1 \u75ab\u82d7\u63a5\u79cd<\/p>\n

\u75ab\u82d7\u63a5\u79cd\u53ef\u4ee5\u4e00\u5b9a\u7a0b\u5ea6\u9884\u9632 CAP \u7684\u53d1\u75c5\u3002\u63a8\u8350\u6210\u4eba\u63a5\u79cd\u6d41\u611f\u75c5\u6bd2\u75ab\u82d7 \uff1b\u5bf9\u4e8e\u5e74\u9f84\u5927\u4e8e 60 \u5c81\u6216\u5c5e\u4e8e\u5371\u9669\u7fa4\u4f53\uff08\u6162\u6027\u80ba\u90e8\u75be\u75c5\u3001\u6162\u6027\u5fc3\u8840\u7ba1\u75be\u75c5\u3001\u7cd6\u5c3f\u75c5\u3001\u6162\u6027\u80be\u529f\u80fd\u8870\u7aed\u3001\u80be\u75c5\u7efc\u5408\u5f81\u3001\u6162\u6027\u809d\u75c5\u3001\u514d\u75ab\u529f\u80fd\u4f4e\u4e0b\u3001\u529f\u80fd\u6216\u5668\u8d28\u6027\u65e0\u813e\u3001\u957f\u671f\u5c45\u4f4f\u517b\u8001\u9662\u6216\u5176\u4ed6\u533b\u7597\u673a\u6784\u6216\u5438\u70df\u8005\uff09\u7684\u60a3\u8005\u63a8\u8350\u63a5\u79cd\u80ba\u708e\u94fe\u7403\u83cc\u75ab\u82d7\u548c\u6d41\u611f\u75c5\u6bd2\u75ab\u82d7\u3002\u901a\u5e38\u63a5\u79cd\u75ab\u82d7 2~4 \u5468\u540e\u53ef\u4ea7\u751f\u5177\u6709\u4fdd\u62a4\u6c34\u5e73\u7684\u6297\u4f53\u3002\u8003\u8651\u6211\u56fd\u6bcf\u5e74\u6d41\u611f\u75c5\u6bd2\u6d3b\u52a8\u9ad8\u5cf0\u51fa\u73b0\u7684\u65f6\u95f4\u548c\u6301\u7eed\u65f6\u95f4\u4e0d\u540c\uff0c\u5efa\u8bae\u53ca\u65f6\u63a5\u79cd\u75ab\u82d7\u3002<\/p>\n

11.2.2 \u751f\u6d3b\u65b9\u5f0f<\/p>\n

\u5efa\u8bae\u4fdd\u6301\u826f\u597d\u7684\u536b\u751f\u4e60\u60ef\uff0c\u7ecf\u5e38\u6d17\u624b\uff0c\u4fdd\u6301\u53e3\u8154\u6e05\u6d01\u3002\u6212\u70df\u3001\u907f\u514d\u9157\u9152\uff0c\u4fdd\u8bc1\u4f11\u606f\uff0c\u5747\u8861\u996e\u98df\uff0c\u9884\u9632\u4fbf\u79d8\uff0c\u4fdd\u6301\u5927\u4fbf\u901a\u7545\u548c\u907f\u514d\u80a0\u9053\u83cc\u7fa4\u5931\u8c03\u3002\u6709\u54b3\u55fd\u3001\u55b7\u568f\u7b49\u547c\u5438\u9053\u75c7\u72b6\u65f6\u6234\u53e3\u7f69\u6216\u7528\u7eb8\u5dfe\u906e\u6321\u53e3\u9f3b\uff0c\u4e0d\u53bb\u4eba\u7fa4\u5bc6\u96c6\u5730\u3002<\/p>\n

11.2.3 \u4f53\u80b2\u953b\u70bc<\/p>\n

\u6839\u636e\u4e2a\u4eba\u4f53\u8d28\uff0c\u53c2\u4e0e\u9002\u5f53\u7684\u4f53\u80b2\u953b\u70bc\u3002\u53ef\u91c7\u53d6\u6162\u8dd1\u3001\u6e38\u6cf3\u4ee5\u53ca\u81ea\u6211\u7ec3\u4e60\u4f20\u7edf\u5bfc\u5f15\u672f\u3001\u6c14\u529f\u3001\u6b66\u672f\u7b49\uff0c\u4ee5\u589e\u5f3a\u4f53\u8d28\uff0c\u9884\u9632 CAP \u7684\u53d1\u751f\u3002<\/p>\n

\u901a\u4fe1\u4f5c\u8005\uff1a\u5f90\u519b\uff0cEmail: xujunfree@126.com\uff1b\u66f9\u94b0\uff0cEmail: caoyu@wchscu.cn\uff1b\u6731\u534e\u680b\uff0cEmail: zhuhuadong1970@126.com\uff1b\u8d75\u6653\u4e1c\uff1bEmail: zxd63715@126.com\uff1b\u4e8e\u5b66\u5fe0\uff0cEmail: yxz@medmail.com.cn<\/p>\n","protected":false},"excerpt":{"rendered":"

\u793e\u533a\u83b7\u5f97\u6027\u80ba\u708e\uff08 community acquired pneumon … \u7ee7\u7eed\u9605\u8bfb →<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[70],"tags":[],"class_list":["post-50699","post","type-post","status-publish","format-standard","hentry","category-70"],"_links":{"self":[{"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=\/wp\/v2\/posts\/50699","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=50699"}],"version-history":[{"count":0,"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=\/wp\/v2\/posts\/50699\/revisions"}],"wp:attachment":[{"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=50699"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=50699"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=50699"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}