文档介绍：社区获得性肺炎的新认知广州呼吸病研究所陈荣昌?甲型H1N1流感流行使CAP临床诊治面临新的挑战?CAP病原学诊断困难赋予经验性治疗更沉重的责任?推行体现CAP规范化诊治的临床路径时需要特别重视个体化的处理20092009年,年,H1N1H1N1流感流感及季节性流感成为及季节性流感成为全球关注的热点全球关注的热点截至截至20092009年年1111月月2020日,全球日,全球H1N1H1N1的死亡人数已超过的死亡人数已超过78007800人人(CDC)(CDC)阿根廷甲流患者死亡率要高阿根廷甲流患者死亡率要高于世界其它地区于世界其它地区(%%),(%%),哥伦比亚大学哥伦比亚大学PalaciosPalacios报告,合并细菌的混合感染可报告,合并细菌的混合感染可能为导致这一现象的主要原因能为导致这一现象的主要原因Cioti SK et al. Biosecuricy and Bioterrorism: Biodefc:nse Strategy. SK et al. Biosecuricy and Bioterrorism: Biodefc:nse Strategy. Practice. 2009 .7(3.); 2009 .7(3.); 311- 311-. Gustavo Palacios et al. PLoS ONE,2009; 4(12): e8540. Gustavo Palacios et al. PLoS ONE,2009; 4(12): :2010-01-09 WHO报告全球H1N1流感死亡至少12799人;2010-02-25 中国卫生部统计全国死于H1N1流感775例The young are disproportionately affectedThe young are disproportionately affected??Attack rate highest in children 5-14 years (147/ 100K), Attack rate highest in children 5-14 years (147/ 100K), 14 times14 times higher than adults aged higher than adults aged ≥≥ 60 60??Overall case-fatality rates similar to seasonal flu so farOverall case-fatality rates similar to seasonal flu so farMMWR 2009, 58(33);913-918Case-fatality proportion by ageCase-fatality proportion by ageJAMA 2009, 302(17);1896-1902Factors associated with hospitalization Factors associated with hospitalization and deathand death??60% of children and 72% of adults had 60% of children and 72% of adults had underlying conditionsunderlying conditions??Of 268 adults with known BMI, 58% were Of 268 adults with known BMI, 58% were BMIBMI≥≥30 and 43% were BMI30 and 43% were BMI≥≥4040??The median time from onset of symptoms to The median time from onset of symptoms to hospitalization was 2 days (0-31 days)hospitalization was 2 days (0-31 days)??31% admitted to ICU31% admitted to ICU??51% received antiviral within 48 hours51% received antiviral within 48 hours??4% had secondary bacterial infection4% had secondary bacterial infection??11% died11% diedJAMA, 2009;302(17):1896