重症肺炎临床及预后因素分析

Clinical Aspects and Prognostic Factors of Severe Pneumonia

目的了解重症肺炎流行病学、病原学、临床诊治现状及预后相关因素。方法以中山大学附属第一医院出院符合重症肺炎诊断标准的病例为研究对象,采用回顾性病例对照研究及Logistic回归分析其预后相关因素。结果重症社区获得性肺炎(SCAP)病死率为45.0%,重症医院获得性肺炎(SHAP)为58.5%;高龄、心功能不全、人工气道和感染性休克为SCAP的预后危险因素,初始抗菌药物联合用药为保护性因素;心功能不全、感染性休克、心动过速为SHAP的预后危险因素。结论肺炎所致严重系统炎症反应是重症肺炎主要的预后危险因素,尽早进行足量抗菌药物经验治疗对疾病预后有重要影响。

OBJECTIVE To conclude and analyze epidemiology, etiology, diagnostic, treatment and prognostic factors of local adult hospitalized patients with severe pneumonia. METHODS A retrospective analysis with case- control study was designed. All the medical records of consecutive patients aged ≥ 18 yrs with diagnosis of pneumonia from Sep 2000 to Sep 2005 in the First Affiliated Hospital of Sun Yat-sen University were searched. Contribution of the factors to prognosis was determined by multivariate analysis with Logistic regression. RESULTS In the severe community-acquired pneumonia （SCAP） subgroup, mortality was 45.0%; and in the severe hospital-acquired pneumonia （SHAP） subgroup, mortality was 54. 8%. In the SCAP subgroup, there were five factors associated with prognosis on multivariate analysis： age （≥75yrs）, heart failure, intubation and septic shock were risk factors; initial combined antibiotic therapy was protective factors. In the SHAP subgroup, factors associated with prognosis on multivariate analysis were heart failure, septic shock and heart rate ≥ 100bpm; all were risk factors, CONCLUSIONS Septic shock and heart failure are associated with mortality both in SCAP and SHAP, which suggest that severe systemic inflammatory response associated with the pulmonary infection be an important prognostic factor in the outcome of severe pneumonia. Initial appropriate antibiotic empiric therapy was important to the prognosis.