重症社区获得性肺炎病原微生物调查和预后因素分析  

Investigation of pathogens in severe community-acquired pneumonia and analysis of prognostic factors

作　　者：刘宇智[1] 金宁[1] 张潭军 

机构地区：[1]惠州市第六人民医院(南方医科大学附属惠阳医院),广东惠州516211

出　　处：《临床肺科杂志》2017年第9期1574-1576,共3页Journal of Clinical Pulmonary Medicine

基　　金：2014年惠州市科技计划项目(No 2014Y193)

摘　　要：目的了解重症社区获得性肺炎主要病原微生物和预后因素。方法回顾性分析2013年5月到2016年5月入住我院的68例重症社区获得性肺炎(serious community-acquired pneumonia,SCAP)患者的相关临床资料,根据患者的预后情况将所有患者分为死亡组及存活组,采用单因素分析比较两组观察指标,对有显著差异的指标采用多因素回归分析,以了解影响患者预后的危险因素。对所有患者痰液、经纤维支气管镜或人工气道吸引样本进行病原微生物培养,以了解病原微生物类型。结果 35例患者细菌培养结果为阳性,其中铜绿假单胞菌11例,肺炎克雷伯菌6例,金黄色葡萄球菌5例,流感嗜血杆菌4例,嗜麦芽假单孢菌3例,肺炎链球菌2例,鲍曼不动杆菌2例,肺炎支原体2例;感染性休克、心功能不全、慢阻肺、有创机械通气、年龄≥65岁为独立危险因素,初始抗菌联合用药为保护性因素。结论患者病原学总体以革兰氏阴性杆菌为主,流感嗜血杆菌最为常见。初始抗菌联合用药的患者预后较好,感染性休克、心功能不全、慢阻肺、有创机械通气、年龄≥65岁的患者预后较差。Objective To investigate the main pathogenic microorganisms and prognostic factors of severe community-acquired pneumonia. Methods The clinical data of 68 patients with severe community-acquired pneumonia( SCAP) from May 2013 to May 2016 were retrospectively analyzed. Single factor analysis was used to compare the observation indexes of the two groups,and multiple regression analysis was used to understand the risk factors of prognosis. For all patients,sputum by bronchoscopy or artificial airway attract samples of pathogenic bacteria were cultured to understand the pathogenic bacteria types. Results 23 patients were with positive bacterial culture,including 11 cases of Pseudomonas aeruginosa,6 cases of Klebsiella pneumonia,5 cases of Staphylococcus aureus,4 cases of Haemophilus influenzae,3 cases of Pseudomonas maltophilia,2 cases of Streptococcus pneumonia,and 1 case of Acinetobacter Bauman. Septic shock,heart failure,COPD,mechanical ventilation,older than 65 years were the independent risk factors of SCAP,while the initial antibiotic combination the protective factors. Conclusion Gram negative bacilli are the main pathogens in SCAP patients,and Haemophilus influenzae is the most common. The prognosis of patients with initial antimicrobial drug combination is better,patients with septic shock,heart failure,COPD,mechanical ventilation,or older than 65 years have poor prognosis.

关 键 词：重症社区获得性肺炎 病原微生物调查 预后因素 

分 类 号：R563.1[医药卫生—呼吸系统]