重症肺炎合并重度急性呼吸窘迫综合征患者临床特点与预后影响因素分析  

Clinical characteristics of severe pneumonia patients complicated with severe acute respiratory distress syndrome and influecing factors for prognosis

作　　者：张志强[1] 马海英[2] 冯宪军[1] 杨艳荣[1] 郭悦鹏[1] 

机构地区：[1]新乡医学院第一附属医院呼吸内科,河南新乡453100 [2]新乡医学院第一附属医院心血管外科,河南新乡453100

出　　处：《中华医院感染学杂志》2016年第6期1297-1299,共3页Chinese Journal of Nosocomiology

基　　金：河南省医学科技攻关基金资助项目(200803073)

摘　　要：目的探讨呼吸重症监护病房(RICU)重症肺炎合并重度急性呼吸窘迫综合征(ARDS)的临床特点及预后影响因素,为临床病毒肺炎诊治提供临床参考。方法对2012年1月-2014年8月医院救治的160例RICU重症肺炎合并重度ARDS患者临床资料进行回顾性分析,根据患者病死情况分为病死组109例与存活组51例,调查感染病原体分布,分析重症肺炎合并重度ARDS的临床特点及其预后影响因素,并采用SPSS 17.0进行统计分析。结果 160例重症肺炎合并重度ARDS患者,病死109例,病死率为68.13%;经病原学确诊H1N1 25例、柯萨奇病毒9例、巨细胞病毒8例;细菌感染39例,继发真菌感染23例,合并真菌感染16例;病死组患者的平均年龄明显高于存活组,差异有统计学意义(t=5.27,P<0.05);病死组患者的RICU住院时间及机械通气时间明显少于存活组,比较差异有统计学意义(t=12.36、8.95,P<0.05);病死组患者的氧合指数明显低于存活组,差异有统计学意义(t=4.37,P<0.05)。结论 RICU中重症肺炎合并重度ARDS有较高的病死率,其中患者的平均年龄、RICU住院时间、机械通气时间及氧合指数与预后相关。OBJECTIVE To explore the clinical characteristics of severe pneumonia complicated with severe acute respiratory distress syndrome（ARDS）in respiratory intensive care unit（RICU）and analyze the influencing factors for prognosis so as to provide guidance for clinical diagnosis and treatment of the viral pneumonia.METHODS A total of 160 severe pneumonia patients complicated with severe ARDS who were treated in the RICU from Jan 2012 to Aug 2014 were enrolled in the study,then the clinical data of the patients were retrospectively analyzed,the patients were divided into the death group with 109 cases and the survival group with 51 cases according to the status of prognosis,the distribution of pathogens was investigated,the clinical characteristics of the severe pneumonia complicated with severe ARDS were observed,the influencing factors for the prognosis were analyzed,and the statistical analysis was performed with the use of SPSS 17.0software.RESULTS Of 160 severe pneumonia patients complicated with ARDS,109 died,with the mortality rate 68.13%.The etiological analysis showed that 25 patients were tested positive for H1N1,9patients tested positive for Coxsackie virus,8patients tested positive for cytomegalovirus.Totally 39 patients had bacterial infections,23 patients had secondary fungal infections,and 16 patients had mixed fungal infections.The average age of the death group was significantly higher than that of the survival group（t=5.27,P0.05）.The length of RICU stay and mechanical ventilation duration were significantly shorter in the death group than in the survival group（t=12.36、8.95,P0.05）.The oxygenation index of the death group was significantly lower than that of the survical group（t=4.37,P0.05）.CONCLUSION The mortality rate of the severe pneumonia patients complicated with severe ARDS is high in the RICU.The prognosis is associated with the average age,length of RICU stay,mechanical ventilation duration,and oxygenation index.

关 键 词：急性呼吸窘迫综合征 病毒性肺炎 呼吸重症监护病房 预后 

分 类 号：R563.1[医药卫生—呼吸系统]