重症社区获得性肺炎病死率及预后分析

目的探讨重症社区获得性肺炎(severe community-acquired pneumonia,SCAP)的住院病死率及预后相关因素。方法收集大坪医院2009年1月至2010年6月期间住院的SCAP患者73例,对病死率进行单因素分析(t检验和χ2检验)及多因素Logistic回归分析。结果单因素分析发现,治疗前APACHEⅡ评分≥16分、治疗3d后临床肺部感染评分(CPIS)升高、D-二聚体水平、pH7.30、PaCO2≥50mm Hg、双叶或多肺叶受累、合并慢性阻塞性肺疾病(COPD)以及多器官功能衰竭与SCAP死亡有关。多因素Logistic回归分析发现,治疗前APACHEⅡ评分≥16分[比值比(OR)=6.40,95%可信空间(CI)2.60～18.87]、治疗3d后CPIS升高(OR=6.90,95%CI2.03～29.13)、多器官功能衰竭(OR=6.32,95%CI1.33～21.06)是影响SCAP预后的独立危险因素。结论治疗前APACHEⅡ评分可作为评估SCAP预后的良好指标,对CPIS的动态监测有助于SCAP的疗效评价,D-二聚体水平与SCAP预后有明显相关性。

The mortality and prognostic factors of severe community acquired pneumonia

Objective To study the mortality and prognostic factors of severe community-acquired pneumonia（SCAP）. Methods The data of 73 cases of SCAP from Jan 2009 to Jun 2010 in Daping Hospital were retrospectively analyzed. Univariate analysis （t test and X2 test） and multivariate logistic regression analysis were used to identify variables associated with mortality for SCAP. Results Univariate analysis showed that APACHE Iseore I〉 16 before treatment, clinical pulmonary infection score（CPIS） increased after three-day treatment, D-dimer, pH 〈 7.30 and PaCO2 ≥50 mm Hg, double or multi-lobar lung affectation, complicated with chronic obstructive pulmonary disease （COPD）, multi-organ failure had significant differences between the survivor and non-survivor, multivariate logistic regression analysis identified three independent risk factors as APACHE il score≥16 before treatment[odds ratio（OR） =6.40, 95% confidence interval（CI） 2. 60 - 18.87], CPIS rise after three-day treatment（OR =6.90, 95% CI 2.03 -29. 13） and multi-organ failure（OR = 6.32, 95% CI 1.33 -21.06）. Condusion APACHE II score was valuable in evaluating the prognosis, monitor CPIS was helpful to appraise the curative effect of SCAP, the D-dimer was also obviously associated with prognosis of SCAP.