无反应肺炎的危险因素分析及病原学调查  

Risk factors of nonresponding pneumonia and etiological investigation

作　　者：黄锡坤[1] 郭伟洪[1] 缪卓峰 夏秀琼[1] 林宇鹏[1] 陈维[1] 黄大钡[1] Huang Xikun;Guo Weihong;Miu Zhuofeng;Xia Xiuqiong;Lin Yupeng;Chen Wei;Huang Dabei(Respiratory Medicine Department,Zhongshan City People's Hospital,Zhongshan 528400,China)

机构地区：[1]中山市人民医院呼吸内科,528400

出　　处：《国际医药卫生导报》2018年第13期1924-1928,共5页International Medicine and Health Guidance News

基　　金：中山市科技局攻关项目课题(2014A1FC096)。

摘　　要：目的 观察分析无反应肺炎(NRP)的危险因素分析及病原学调查的应用价值。方法 选择2014年3月至2017年10月期间本科住院收治的无反应肺炎患者87例,并同期选择正常反应肺炎住院患者87例作为对照组,并比较两组的危险因素、临床表现等结果。结果 无反应肺炎组高龄(OA)、慢性阻塞性肺气肿(COPE)、慢性肾功能不全(CRI)、低蛋白血症(Hypoproteinemia)、脑血管疾病(CD)与正常反应肺炎组比较差异有统计学意义(χ2=6.606、8.281、9.334、23.071、9.103,P<0.05),慢性阻塞性肺气肿(COPE)、低蛋白血症、慢性肾功能不全(CRI)、脑血管疾病(CD)是独立危险因素,无反应肺炎组发热、胸闷气短及啰音与正常反应肺炎组比较差异有统计学意义(χ2=10.573、7.441、5.529,P<0.05),无反应肺炎组WBC、N%、PCT、CRP、血沉与正常反应肺炎组(P<0.05),无反应肺炎组多肺叶浸润及胸腔积液间与正常反应肺炎组比较差异有统计学意义(χ2=61.271、33.645,P<0.05)。无反应肺炎患者87例共检出88株病菌,其中肺炎链球菌45株占51.14%(45/88),G-阴性杆菌37株占42.05%(37/88,包括克雷白杆菌17株,大肠杆菌14株,流感嗜血杆菌6株),军团菌4株占4.55%(4/88),其他病原体2株占2.27%(2/88)。结论 慢性基础疾病和特殊病原体感染是社区获得性肺炎(CAP)的危险因素。CAP患者初始治疗时常常表现炎性反应较为严重。多肺叶浸润及胸腔积液可以明显的提早识别CAP,为患者治疗提供客观依据。Objective To analyze the risk factors of nonresponding pneumonia(NRP)and etiological investigation.Methods Eighty-seven patients with NRP admitted to our department from March 2014 to October 2017 were enrolled in this study,eighty-seven inpatients with normal-response pneumonia were enrolled during the same period.The risk factors,clinical manifestations,and other results of the two groups were compared.Results There were statistically significant differences in the rates of old age(OA),chronic obstructive pulmonary emphysema(COPE),chronic renal insufficiency(CRI),hypoproteinemia,cerebrovascular disease(CD)between NRP group and normal-response pneumonia group(χ2=6.606,8.281,9.334,23.071,9.103;P<0.05).Chronic obstructive pulmonary emphysema(COPE),chronic renal insufficiency(CRI),hypoproteinemia,cerebrovascular disease(CD)were independent risk factors.There were statistically significant differences in the rates of fever,shortness of breath,and rale between NRP group and normal-response pneumonia group(χ2=10.573,7.441,5.529;P<0.05).There were statistically significant differences in WBC,N%,PCT,CRP,erythrocyte sedimentation rate between NRP group and normal-response pneumonia group(P<0.05).There were statistically significant differences in the rates of polypulmonary infiltration and pleural effusion between NRP group and normalresponse pneumonia group(χ2=61.271,33.645;P<0.05).88 strains of bacteria were detected in 87 cases of NRP group,including 45 strains of Streptococcus pneumoniae(51.14%),37 strains of G-negative bacilli(42.05%)(17 strains of Klebsiella pneumoniae,14 strains of Escherichia coli,6 strains of Haemophilus influenzae),4 strains of Legionella(4.55%),other 2 strains of pathogens(2.27%).Conclusion Chronic basic diseases and special pathogen infection are risk factors of community-acquired pneumonia(CAP).The patients with CAP often show more serious inflammatory reaction during the initial treatment.Multi-lobe infiltration and pleural effusion can effectively identify CAP early,to provide an object

关 键 词：无反应肺炎 危险因素 病原学调查 

分 类 号：R446.5[医药卫生—诊断学] R563.1[医药卫生—临床医学]