无呼吸道症状的社区获得性肺炎282例临床分析

Clinical analysis of 282 cases of community acquired pneumonia without respiratory symptoms

目的：分析无呼吸道相关症状的社区获得性肺炎（CAP）的特征。方法：分析北京宣武医院发热门诊2006年3月～2008年7月接诊的282例无呼吸道相关症状的CAP患者的临床特征。结果：282例无呼吸道相关症状的CAP患者中14～39岁164例，占58．2％；体温（腋下）大于39．0℃的患者261例，占92．6％。198例在发热3d内确诊，占70．2％；既往健康者227例，占80．5％，有慢性病史者55例，占19．5％；血白细胞增高者113例，占40．1％，白细胞正常147例，占52．1％，白细胞降低22例，占7．8％。胸片检查，左侧肺炎115例，占40．8％，右侧肺炎117例，占41．5％，双侧肺炎50例，占17．1％；病原学检测，住院的21例患者血培养及支原体抗体检测结果均为阴性。51例口服抗生素治疗的患者，45例3d退热，占88．2％；231例静脉抗生素治疗，207例3d退热，占89．6％，两者相比无显著性差异（P〉0．05）；1W复查胸片，肺炎明显吸收204例，占72．3％，无明显吸收78例，占27．7％，两者相比差异有显著性意义（P〈0．05）。结论：无呼吸道相关症状的CAP患者大多数年轻，既往健康，只要掌握其临床特征，诊治并不困难。

Objective： To analyze the clinical features of community acquired pneumonia （CAP） without respiratory symptoms. Methods ：282 CAP patients without respiratory symptoms except the fever visiting our fever clinic from March,2006 to July,2008 were enrolled in this study and their clinical features were analyzed. Results： 164 of 282 CAP patients were 14 - 39 years old（58.2% ） ;body temperature （armpit）of 261 cases was over 39.0℃ （92.6%） ;198 eases were final diagnosed as CAP within 3 days（70.2% ） ;227 cases were previously healthy （80.5%） ,55 cases with history of chronic diseases（ 19.5% ） ;113 cases with higher white cell count than normal（40.1% ）, 147 cases with normal white cell count （52.1% ） ,22 cases with lower white cell count than normal （7.8%） ;115 cases with left pneumonia （40.8%） , 117 eases with fight pneumonia （41.5）,50 cases with pneumonia of two sides （17. 1% ）;21 hospitalized cases receiving aetiology detection showed negative hemocuhure and mycoplasma antibody ; among 51 cases treated with oral antibiotics, fever of 45 （ 88.2% ） cases disappeared within 3 days while among 231 cases treated with antibiotics iv drop ,fever of 207 cases disappeared within 3 days（ 89.6% ） ,and there was no significant difference between them（ P 〉 0.05）. After one - week treatment, X - ray review demonstrated that pneumonia of 204 cases improved （72.3%） and 78 cases didn＇t improve obviously（27.7% ）, and there was significant difference between them （ P 〈 0.05 ）. Conclusion： Most of CAP patients without respiratory symptoms are young and previously healthy. Therefore,it isnt difficult to diagnose and treat this disease if we understand its clinical features.