中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

重症社区获得性肺炎患者预后危险因素分析

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目的 建立重症社区获得性肺炎病原预后分析模型,筛选死亡独立危险因素。 方法 从 2012 年 4 月至 2015 年 12 月福建省立医院的 533 例社区获得性肺炎患者中筛选出 88 例重症社区获得性肺炎患者,根据转归分为死亡组及存活组。收集患者的人口学、临床资料、治疗措施、治疗转归及肺炎严重程度相关指标。利用单因素分析筛查死亡相关危险因素,并经 Logistic 多元回归分析死亡独立危险因素。 结果 根据病原检出情况分为病毒组、细菌组、混合感染组、阴性组和其他组,各组的死亡率差异无统计学意义(P>0.05)。单因素分析发现住院前使用过抗生素、高急性生理学和慢性健康状况评分系统 Ⅱ 评分、高肺炎严重度指数、高 Chalison 评分、脓毒血症、高降钙素原、高血尿素氮、高血糖、高乳酸水平是死亡的危险因素(均P<0.05),未行抗病毒治疗及有创机械通气患者死亡风险增加(均P<0.05)。经 Logistics 回归分析,筛选出死亡的独立危险因素,包括乳酸、血尿素氮、心率升高,OR 值分别为 4.704(95%CI 0.966~22.907)、1.264(95%CI 0.994~1.606)和 1.081(95%CI 1.003~1.165),未进行有创机械通气为死亡的保护因素(OR=0.033,95%CI 0.001~0.764)。 结论 重症社区获得性肺炎乳酸水平升高、心率增快、血尿素氮升高、进行有创机械通气者预后较差。

Objective To establish a model for prognosis analysis of severe community-acquired pneumonia in order to find the independent risk factors for mortality. Methods The data of 88 patients with severe community-acquired pneumonia enrolled from 533 community-acquired pneumonia patients in Fujian Provincial Hospital from April 2012 to December 2015 were analyzed, they were divided into a survival group and a death group according to prognosis. The clinical materials of basic data of the population, clinical manifestation, treatment and prognosis and pulmonary severity indexes were collected. Then univariate analysis was used to screen risk factors of death before logistic multivaritae regression was applied to explore independent risk factors. Results The different pathogen groups including viral, bacterial, mixed infection, negative and other groups were compared and no differences were found in mortality (all P>0.05). Univariate analysis revealed antibiotics treatment before admission, higher APACHEⅡ score, higher Chalison's score, septicopyemia, and higher level of procalcitonin, blood urea nitrogen (BUN), blood glucose, lactate could increase death risk for the patients. While antiviral treatment and no invasive mechanical ventilation were determined as protective factors. Logistic multivaritae regression showed three factors including higher lactate and higher serum BUN and higher heart rates were independent death risk factors [OR values were 4.704 (95%CI 0.966-22.907), 1.264 (95%CI 0.994-1.606), and 1.081 (95%CI 1.003-1.165), respectively]. Whereas no invasive mechanical ventilation was protective factor (OR=0.033, 95%CI 0.001-0.764). Conclusion The patients with higher lactate and BUN, higher heart rate and accepting invasive mechanical ventilation have poor prognosis.

关键词: 重症肺炎; 社区获得性肺炎; 预后; 死亡; 独立危险因素

Key words: Severe pneumonia; Community-acquired pneumonia; Prognosis; Mortality; Independent risk factors

引用本文: 李鸿茹, 林晓红, 林丹, 陈诗杰, 俞婷, 毛文平, 吕辉迎, 练发扬, 谢剑峰, 郑奎城, 陈愉生. 重症社区获得性肺炎患者预后危险因素分析. 中国呼吸与危重监护杂志, 2018, 17(5): 450-455. doi: 10.7507/1671-6205.201804017 复制

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