社区获得性肺炎并发肺炎旁胸腔积液/脓胸的主要病原学类型及危险因素分析  

Analysis of the Main Pathogenic Types and Risk Factors of Community Acquired Pneumonia Complicated with Pleural Effusion/Empyema

作　　者：周晓莲 李多 Zhou Xiao-lian;Li Duo(Department of respiratory and critical care medicine,Chengdu Second People’s Hospital,Chengdu 610017;Department of Pulmonary and Critical Care Medicine,the Affiliated Hospital of Southwest Medical University,Luzhou Sichuan 646000)

机构地区：[1]成都市第二人民医院呼吸与危重症医学科,成都610017 [2]西南医科大学附属医院呼吸与危重症医学科,四川泸州646000

出　　处：《国外医药(抗生素分册)》2024年第6期427-432,共6页World Notes on Antibiotics

摘　　要：目的研究分析脓胸的主要病原学类型及相关危险因素。方法回顾性分析我院确诊为肺炎并发肺炎旁胸腔积液的住院患者(分为对照组和病例组),对病例组脓液培养结果进行病原学分析,通过对比两组患者临床资料特点分析肺炎性脓胸的危险因素,以期对严重肺部感染发展为脓胸进行干预和以减少死亡率。结果在单因素分析中,两组在营养状况、住院时长、糖尿病、酗酒等方面(P<0.05),是肺炎并发脓胸的危险因素。在Logistic回归分析中,有糖尿病史、酗酒、胸水引流充分与否、白细胞计数高低、C反应蛋白水平、血小板浓度高低、血清白蛋白水平是肺炎性脓胸的独立危险因素。脓液细菌学培养结果是革兰阴性菌中大肠埃希菌(11.67%)发生率高,而在革兰阳性菌中草绿色链球菌(23.33%)感染率较高。结论肺炎合并脓胸的危险因素是多方面的,为避免肺炎发展为复杂肺炎旁胸腔积液/脓胸,临床医生应该尽早识别严重肺部感染并发症,早期使用敏感抗生素和胸腔闭式引流的干预治疗,以期提高临床疗效和预后。Objective To study and analyze the main pathogenic types and related risk factors of empyema.Method Hospitalized patients with pneumonia complicated by pleural effusion in our facility were the subjects of a retrospective analysis(control group and case group).Pathogenic analysis was conducted on the pus culture results of the case group.By comparing the clinical data characteristics of the two groups of patients,the risk factors of pneumonia induced empyema were analyzed,in order to intervene in the development of severe lung infection into empyema and reduce mortality.Results In the univariate analysis,the nutritional status,length of hospitalization,diabetes,alcoholism,etc.of the two groups were P<0.05,which were the risk factors of pneumonia complicated with empyema.In the logistic regression analysis,the history of diabetes,alcoholism,adequate drainage of pleural effusion,high or low white blood cell count,C-reactive protein size,platelet size,and serum albumin level were independent risk factors for pneumonia empyema.Gram negative bacteria had a high incidence of Escherichia coli(11.67%),while Gram positive bacteria had a higher infection rate of Streptococcus viridis(23.33%),according to the results of bacterial culture in pus.Conclusion The risk factors for pneumonia combined with empyema are multifaceted.Clinical physicians should detect serious complications from pulmonary infections as soon as possible,treat them with closed thoracic drainage intervention and sensitive antibiotics to improve clinical efficacy and prognosis,and prevent pneumonia from progressing to complex pleural effusion/empyema.

关 键 词：社区获得性肺炎 肺炎旁胸腔积液 合并症 脓胸 病原学类型 危险因素 

分 类 号：R978[医药卫生—药品]