42例社区获得性耐甲氧西林金黄色葡萄球菌肺炎的临床特点及预后因素的分析研究

Analysis of clinical characteristic and risk factor for prognosis in 42 cases of patients with community acquired-MRSA pneumonia

目的:探讨社区获得性耐甲氧西林金黄色葡萄球菌性(CA-MRSA)肺炎的临床特点及影响其预后的危险因素。方法:回顾性收集2010年1月至2014年12月收住我院的CA-MRSA肺炎患者132例的临床资料,对其临床特点和影响预后的危险因素进行统计分析。结果:最终有42例纳入本研究,气促为最常见的临床表现,共40例(95.24%),再者依次为高热38例(90.48%),咳嗽35例(83.33%),休克25例(59.52%),流感样症状17例(40.48%),意识障碍15例(35.71%),咯血14例(33.33%),胸痛9例(21.43%),胃肠道症状9例(21.43%),皮疹6例(14.29%);其中死亡17例,病死率为40.48%;单因素分析表明入住ICU、机械通气、多脏器功能不全、休克、呼吸衰竭、弥漫性血管内凝血、白细胞减少、流感样症状、皮疹是与死亡相关的危险因素。结论:对CA-MRSA肺炎临床特点的的认识将有利于早期诊断及治疗,探索危险因素对预后的影响,为及时采用有效的治疗措施,改善其预后将有较大的临床意义。

Objective：To investigate the clinical characteristic and risk factors for prognosis in patients with community ac-quired methicillinresistant Staphylococcus aureus（ CA-MRSA） pneumonia. Methods：We retrospectively collected the clinical informa-tion of 132 patients with community acquired-MRSA pneumonia admitted to our hospital from January of 2010 to December of 2014,and analyzed the clinical characteristics and risk factors for prognosis. Results：Ultimately 42 cases included in the study,tachypnoea was the most common symptom in 40 cases（95. 24%）,followed by fever in 38 cases（90. 48%）,cough in 35 cases（83. 33%）,shock in 25 cases（59. 52%）,symptoms like influenza in 17 cases（40. 48%）,confusion in 15 cases（35. 71%）,haemoptysis in 14 cases（33. 33%）,chest pain in 9 cases（21. 43%）,gastro-intestinal symptoms in 9 cases（21. 43%）,rash in 6 cases（14. 29%）. 17 cases of death,its mortality was 40. 48%. The univariate analysis showed that hospitalization of ICU,mechanical ventilation,multi-organ failure, shock,respiratory failure,disseminated intravascular coagulation,leucopenia,Influenza like symptoms and rash were the factors associat-ed with death. Conclusion：Recognization of clinical characteristics of CA-MRSA pneumonia is instructive for prompt diagnosis and treatment. To fully put high premium on the risk factors for prognosis will has great clinical significance for improving prognosis and a-dopting effective therapy.