重症军团菌肺炎合并急性呼吸衰竭34例临床特点及预后分析  

Severe community-acquired pneumonia caused by Legionella pneumophila with acute respiratory failure: clinical characteristics and prognosis of 34 cases

作　　者：何蔡为 唐晓[1] 孙兵 李绪言[1] 王睿[1] 李影 储慧文[1] 王荔 童朝晖[1] He Caiwei;Tang Xiao;Sun Bing;Li Xuyan;Wang Rui;Li Ying;Chu Huiwen;Wang Li;Tong Zhaohui(Department of Respiratory and Critical Care Medicine,Beijing Chaoyang Hospital,Capital Medical University,Beijing Institute of Respiratory Medicine,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders,Beijing Engineering Research Center for Diagnosis and Treatment of Respiratory and Critical Care Medicine(Beijing Chaoyang Hospital),Beijing 100020,China;Beijing Prevention and Treatment Hospital of Occupational Disease for Chemical Industry,Beijing 100093,China)

机构地区：[1]首都医科大学附属北京朝阳医院呼吸与危重症医学科,北京呼吸疾病研究所,北京市呼吸与肺循环疾病重点实验室,北京市呼吸与危重症诊治工程技术研究中心(北京朝阳医院),100020 [2]北京市化工职业病防治院呼吸与危重症医学科,100093

出　　处：《中华结核和呼吸杂志》2020年第7期557-563,共7页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：首都临床特色应用研究与成果推广(Z151100004015049);首都卫生发展科研专项(2016-1-1061);首都医科大学附属北京朝阳医院1351人才培养计划(CYXX-2017-01)。

摘　　要：目的探讨重症军团菌肺炎合并急性呼吸衰竭患者的临床特点及影响预后的因素。方法收集2011年10月至2019年10月入住首都医科大学附属北京朝阳医院呼吸重症监护病房(RICU)的34例重症军团菌肺炎合并急性呼吸衰竭病例,并应用多因素logistic回归分析法分析住院患者的病死率及其危险因素。结果34例患者中男25例,女9例,年龄17~82岁,中位年龄为61(48,69)岁。34例患者按是否在RICU住院期间死亡分为死亡组和存活组。存活组24例,男17例,女7例,中位年龄为65(55,70)岁;死亡组10例,男8例,女2例,中位年龄为53(50,58)岁。出现肺炎相关症状至入住RICU的中位时间为7(5,11)d,氧合指数为134(91,216)mmHg(1 mmHg=0.133 kPa),住RICU的中位时间为12(7,22)d。死亡组患者序贯器官衰竭(SOFA)评分为9(7,12)分,显著高于存活组的4(3,8)分(P=0.018);死亡组出现肺炎症状至启动针对性治疗的时间为10(7,14)d,显著高于存活组的4(3,7)d(P=0.019)。多因素logistic回归分析结果显示,SOFA评分升高(OR=1.461,95%CI为1.041~2.051,P=0.028)和出现肺炎症状至启动针对性治疗的时间延长(OR=1.293,95%CI为1.029~1.625,P=0.027)是RICU内病死率升高的独立危险因素。结论RICU中重症军团菌肺炎合并急性呼吸衰竭患者的病死率较高,严重脏器功能不全、启动针对性治疗的时间延迟与RICU病死率升高有关。Objective To describe the clinical characteristics and treatment of severe community-acquired pneumonia(SCAP)caused by Legionella pneumophila with acute respiratory failure and to analyze the risk factors for mortality.Methods From October 2011 to October 2019,34 patients were diagnosed with SCAP caused by Legionella pneumophila with acute respiratory failure.There were 25 males and 9 females,aged from 17 to 82 years,with a median age of 61(48,69)years.According to the prognosis,the patients were divided into a survival group and a death group for comparative analysis.The survival group included 24 patients,17 males and 7 females,with a median age of 65(55,70)years.There were 10 cases in the death group,8 males and 2 females,with a median age of 53(50,58)years.Multivariable logistic regression analysis was used for risk factors of ICU mortality.Results The median time of admission to ICU was 7(5,11)days,the median time of stay in RICU was 12(7,22)days,and the PaO2/FiO2 was 134(91,216)mmHg(1 mmHg=0.133 kPa).Ten patients died during ICU hospitalization,with a mortality of 29%.Sequential organ failure assessment(SOFA)of death group was 9(7,12),which was significantly higher than that of the survival group[4(3,8)],P=0.018.The time from onset of pneumonia symptoms to initiation of targeted treatment of the death group was 10(7,14)d,which was significantly longer than that of the survival group of[4(3,7)d],P=0.019.Multivariable logistic regression analysis showed that SOFA score(OR=1.461,95%CI 1.041-2.051,P=0.028)and the time from onset of pneumonia symptoms to initiation of targeted treatment(OR=1.293,95%CI 1.029-1.625,P=0.027)were independent risk factors for hospital mortality.Conclusions The ICU mortality of severe legionella pneumonia was high.Critical organ dysfunctions and delayed initial targeted treatment were related with the increase of ICU mortality.

关 键 词：军团菌肺炎 呼吸功能不全 重症监护病房 

分 类 号：R563.1[医药卫生—呼吸系统] R563.8[医药卫生—内科学]