社区获得性肺炎合并胸腔积液的临床特点及分析  

Clinical characteristics and analysis of community-acquired pneumonia complicated with pleural effusion

作　　者：陈春秀 韩秀迪 刘学东[1] CHEN Chunxiu;HAN Xiudi;LIU Xuedong(Department of Respiratory and Critical Care Medicine,Qingdao Municipal Hospital,Qingdao,Shandong 266011,P.R.China)

机构地区：[1]青岛大学附属青岛市市立医院呼吸与危重症医学科,山东青岛266011

出　　处：《中国呼吸与危重监护杂志》2021年第8期549-557,共9页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的通过比较伴和不伴胸腔积液的社区获得性肺炎(CAP)患者的临床特征、病原学特点、实验室检查和预后,分析影响合并胸腔积液CAP患者住院30天病死率的危险因素。方法回顾性分析2014年1月1日至2014年12月31日期间我国13个不同地区医院的住院CAP患者临床数据。依据影像学检查,将患者分成合并胸腔积液组(简称PE组)和不合并胸腔积液组(简称非PE组)。比较两组患者的临床资料、治疗、预后及转归。最后采用多因素方法分析胸腔积液患者的30天病死率的危险因素。结果共4781例CAP患者纳入分析,其中胸腔积液患者1169例(24.5%),年龄中位数70岁,并且男性多于女性,既往有吸烟、酗酒、吸入因素、长期卧床、合并基础疾病和出现并发症比例较高,如呼吸衰竭、急性呼吸窘迫综合征(ARDS)、心功能不全、脓毒症休克、急性肾功能衰竭等。PE组患者住院时间延长,重症加强治病病房(ICU)入住率、机械通气率、14天病死率和30天病死率均高于非PE组。多因素分析显示,影响胸腔积液患者30天病死率的危险因素为血尿素氮>7 mmol/L(OR=2.908,95%CI 1.095~7.724)、长期卧床(OR=4.308,95%CI 1.128~16.460)、红细胞比容<30%(OR=4.704,95%CI 1.372~16.135)、急性肾功能衰竭(OR=5.043,95%CI 1.167~21.787)、呼吸衰竭(OR=6.575,95%CI 2.632~16.427)和ARDS(OR=8.003,95%CI 1.852~34.580)。结论CAP合并胸腔积液患者住院时间和住ICU时间均延长,发生并发症的风险增加,住院病死率随患者年龄、合并症、疾病严重程度的升高而显著增加。影响CAP合并胸腔积液患者30天病死率的独立危险因素为血尿素氮>7 mmol/L、长期卧床、红细胞比容<30%、急性肾功能衰竭、呼吸衰竭和ARDS。Objective By comparing the clinical characteristics,etiological characteristics,laboratory examination and prognosis of community acquired pneumonia(CAP)patients with and without pleural effusion(PE),the risk factors affecting the 30-day mortality of CAP patients with PE were analyzed.Methods The clinical data of inpatients with CAP in 13 hospitals in different regions of China from January 1,2014 to December 31,2014 were analyzed retrospectively.According to the imaging examination,the patients were divided into two groups:PE group(with pleural effusion)and non-PE group(without pleural effusion).The clinical data,treatment,prognosis and outcome of the two groups were compared.Finally,multivariate analysis was used to analyze the risk factors of 30-day mortality in patients with PE.Results Of the 4781 patients with CAP,1169(24.5%)were PE patients,with a median age of 70 years,and more males than females,having smoking,alcoholism,inhalation factors,long-term bed rest,complicated with underlying diseases and complications,such as respiratory failure,acute respiratory distress syndrome(ARDS),cardiac insufficiency,septic shock,acute renal failure and so on.The hospitalization time was prolonged;the intensive care unit(ICU)occupancy rate,mechanical ventilation rate,mortality within 14 days and mortality within 30 days in the PE group were higher than those in the non-PE group.Multivariate analysis showed that the risk factors affecting 30-day mortality in the patients with PE were urea nitrogen>7 mmol/L(OR=2.908,95%CI 1.095-7.724),long-term bed rest(OR=4.308,95%CI 1.128-16.460),hematocrit<30%(OR=4.704,95%CI 1.372-16.135),acute renal failure(OR=5.043,95%CI 1.167-21.787)and respiratory failure(OR=6.575,95%CI 2.632-16.427),ARDS(OR=8.003,95%CI 1.852-34.580).Conclusions The hospitalization time and ICU stay of PE patients are prolonged,the risk of complications increases,and the hospital mortality increases significantly with the increase of age,complication and disease severity.The independent risk factors affecting 30-da

关 键 词：肺炎旁胸腔积液 社区获得性肺炎 预后 危险因素 

分 类 号：R563.1[医药卫生—呼吸系统] R561.3[医药卫生—内科学]