天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (10): 1072-1076.doi: 10.11958/20170601

• 临床研究 • 上一篇    下一篇

某医院十年间重症社区获得性肺炎成年患者的 生存状况与病原体研究

顾照华，张东俊，胡建国△   

  1. 张家港，广和中西医结合医院呼吸科（邮编 215600）
  • 收稿日期:2017-05-27 修回日期:2017-08-02 出版日期:2017-10-15 发布日期:2017-10-13
  • 通讯作者: 顾照华 E-mail:375922418@qq.com
  • 作者简介:顾照华（1974），男，本科，副主任医师，主要从事重症肺部感染的诊断与治疗方面研究

Study on survival status and pathogens in adult patients with severe community-acquired pneumonia for the past ten years

GU Zhao-hua, ZHANG Dong-jun, HU Jian-guo△   

  1. Department of Respiration, Guanghe Combinational Hospital of Chinese and Western Medicine of Zhangjiagang, Zhangjiagang 215600, China
  • Received:2017-05-27 Revised:2017-08-02 Published:2017-10-15 Online:2017-10-13

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摘要： 目的 探讨我院十年间重症社区获得性肺炎（SCAP）成年患者的生存状况与病原体的变迁情况。方法 选取 2007 年 1 月—2016 年 12 月我院收治的 159 例 SCAP 成年患者资料，根据入院时间分为早期组（2007 年 1 月— 2011 年 12 月，n=71）和晚期组（2012 年 1 月—2016 年 12 月，n=88）。比较 2 组的临床资料、病原体分布和预后。结 果 （1）晚期组的尿素氮（BUN）＞7.1 mmol/L 比例显著高于早期组（P＜0.05）。2 组的基线资料、生命体征、影像学检 查和其他实验室检查比较差异均无统计学意义（P＞0.05）。（2）病原体分布方面，早期组、晚期组分别有 42、49 例患者 检出病原体，晚期组的嗜肺军团菌感染率显著高于早期组（26.5% vs. 7.1%，P＜0.05）。（3）并发症方面，晚期组的感染 性休克发生率显著高于早期组（22.7% vs. 9.9%，P＜0.05）。晚期组住院后 30 d 内的病死率高于早期组（43.2% vs. 25.4%，P＜0.05）。多因素 Cox 比例风险回归分析结果显示，感染性休克、呼吸性酸中毒是早期组患者死亡的独立危 险因素（P＜0.05）；感染性休克、慢性阻塞性肺疾病、多肺叶浸润是晚期组患者死亡的独立危险因素（P＜0.05）。结 论 我院近十年 SCAP 成年患者的基本临床特征变化不大，但嗜肺军团菌的检出率有升高趋势，其短期内病死率有 所上升，是否合并感染性休克是影响其预后的关键因素。

关键词: 肺炎, 社区获得性感染, 军团病杆菌属, 预后, 社区获得性肺炎, 病原体, 感染性休克

Abstract: Objective To investigate the survival status and pathogens in adult patients with severe communityacquired pneumonia (SCAP) for the past ten years in our hospital. Methods A total of 159 adult patients with SCAP were enrolled for this study from January 2007 to December 2016 in our hospital. Patients were divided into early stage group (from January 2007 to December 2011, n=71) and late stage group (from January 2012 to December 2016, n=88). The clinical data, pathogen distribution and prognosis were compared between two groups. Results (1) The proportion of patients with blood urea nitrogen (BUN) > 7.1 mmol/L was significantly higher in late stage group than that of early stage group (P＜0.05). There were no significant differences in baseline data, vital signs, imaging findings and other laboratory examinations between the two groups (P＞0.05). (2) For distribution of pathogens, 42 and 49 cases were detected pathogens in early stage group and late stage group. The detection rate of Legionella pneumophila was significantly higher in late stage group than that in early stage group (26.5% vs. 7.1%, P＜0.05). (3) For complications, the incidence of septic shock was significantly higher in late stage group than that in the early stage group (22.7% vs. 9.9%, P＜0.05). The fatality rate within 30 d after admission was significantly higher in late stage group than that of early stage group (43.2% vs. 25.4%, P < 0.05). Results of multi-factor Cox proportional hazard regression analysis showed that septic shock and respiratory acidosis were independent risk factors of mortality in early stage group (P＜0.05) while septic shock, chronic obstructive pulmonary disease (COPD) and multi- lobar infiltrates were independent risk factors of mortality in late stage group (P＜0.05). Conclusion In the past ten years, basic clinical characteristics of adult patients with SCAP in our hospital have changed little, but detection rate of legionella has showed increasing trend, and the short-term mortality rate has increased. Whether or not patients are combined with septic shock is a key factor affecting the prognosis.

Key words: pneumonia, community- acquired infections, legionella, prognosis, community- acquired pneumonia, pathogen, septic shock