合并慢性阻塞性肺疾病对重症社区获得性肺炎患者预后的影响

目的 分析合并慢性阻塞性肺疾病（COPD）对于重症社区获得性肺炎（SCAP）患者预后的影响. 方法 回顾性分析2004年1月至2009年12月我院呼吸重症监护室（RICU）收治的成人SCAP患者的临床资料,比较合并COPD与非合并COPD患者临床特征的差异.建立多因素回归模型分析SCAP住院死亡的危险因素. 结果 166例SCAP入选,平均年龄72.3岁,死亡41例,病死率24.7%.合并COPD者以男性（80.6%）及吸烟者（62.7%）居多;铜绿假单胞菌感染率（13.4%）、机械通气（31.3%）和激素治疗（52.2%）的比例、住院病死率（29.9%）均明显高于非COPD患者.多因素回归分析表明合并COPD（OR=8.1,95% CI：4.7～23.9,P＜0.01）、多肺叶或双肺病变（OR=9.3,95% CI：4.5～26.3,P＜0.01）和发生休克（OR=7.0,95% CI：3.2～9.4,P＜0.01）是SCAP患者死亡的独立危险因素. 结论 SCAP患者发病率高、预后差.合并COPD将增加SCAP患者病死率.

The influence of chronic obstructive pulmonary disease on mortality in patients admitted to the intensive care unit for community-acquired pneumonia

Objective To analyze the influence of chronic obstructive pulmonary disease(COPD)on mortality in patients admitted to the intensive care unit for severe community-acquired pneumonia(SCAP). Methods The clinic characteristics,aetiology and evolution of patients with SCAP admitted to our hospital between 2004 and 2009 were analyzed retrospectively.COPD patients were compared with non-COPD patients in baseline characters,etiology and prognosis parameters.The univariate and multiple logistic regression analysis was used for statistical analysis. Results A total of 166 patients was included with a mean age of 72.3 yrs.There were 125 survivors and 41 death,and in-hospital mortality was 24.7%.The proportion of patients who were males(80.6%),smokers (62.7%),infection of Pseudomonas aeruginosa(13.4%),need of mechanical ventilation(31.3%),use of glucocorticoid(52.2%)and ICU mortality(29.9%)was higher in COPD patients.In multivariate analysis the prognostic factors independently associated with in-hospital mortality were coexisting of COPD(OR = 8.1,95% CI:4.7-23.9,P ＜0.01),multilobar or bilateral involvement(OR =9.3,95% CI:4.5-26.3 ,P ＜0.001)and development of shock(OR=7.0,95% CI:3.2-19.4,P＜0.01). Conclusion COPD patients hospitalized with SCAP in the intensive care unit have higher mortality and need more mechanical ventilation compared with patients without chronic obstructive pulmonary disease.