摘要
目的探讨重症社区获得性肺炎(SCAP)患者死亡的危险因素及临床肺部感染评分(CPIS)对SCAP预后的评价,以指导临床救治。方法按照2007年美国感染病学会/美国胸科学会(IDSA/ATS)共同发布的成人社区获得性肺炎(CAP)诊治指南中关于SCAP的界定,分析我院2006—2007年57例SCAP临床资料,并对住院第1、3、5天的CPIS分值进行分析。结果57例SCAP平均年龄(65±18)岁,死亡23例,病死率40%。死亡组住院第1天CPIS(7.0±1.5)、第3天(7.5±1.1)及第5天(9.0±1.7),存活组住院第1天CPIS(6.8±1.1)、第3天(6.2±0.9)及第5天(5.3±1.2),住院第5天CPIS>6分时病死率高,其敏感性和特异性分别为91.3%和82.4%。pH<7.35或二氧化碳分压(PCO2)≥50mmHg的患者病死率显著增高(P<0.01);呼吸次数≥30次/min、合并慢性阻塞性肺病(COPD)、3个及以上器官受累、3个及以上肺叶受累、白细胞≥10×109/L或血清白蛋白<30g/L的患者病死率显著增高(P<0.05)。结论pH<7.35、PCO2≥50mmHg、呼吸≥30次/min、合并COPD、3个及以上器官受累、3个及以上肺叶受累、白细胞≥10×109/L及血清白蛋白<30g/L是SCAP病死率的危险因素;CPIS可作为一个良好的指标用于SCAP预后的评估。
Objective To investigate the risk factors related to death of severe community acquired pneumonia （SCAP） and the value of the clinical pulmonary infection score （CPIS） for the prognosis of SCAP in an attempt to instruct clinical work. Methods According to guidelines of IDSA/ATS 2007 for the management of adults with community acquired pneumonia, 57 patients with severe community acquired pneumonia were enrolled in our hospital from 2006 to 2007. Their clinical data were studied retrospectively. The CPIS score was calculated at the first day of hospi- talization of SCAP, and at 3, 5 days after hospitalization. Results Among the 57 SCAP patients, there were 36 male and 21 female patients. The ages ranged from 19 to 105 years. The mean age was （65 - 18） years. The increase of CPIS was significant in death group at the first day of hospitalization （7.0 ±1.5）, at 3 （7.5 ± 1.1） and 5 （9.0 ± 1.7） days. An decrease of CPIS was significant in survivors at the first day of hospitalization （6.8 ± 1.1 ）, at 3 （6.2 ±0.9 ） and 5 （5.3 ± 1.2） days. In patients with a CPIS〉6 at 5 days after hospitalization, the mortality was higher than those with CPIS ≤6. The sensitivity and specificity of predicted mortality was 91.3% and 82.4% respectively. There were significant differences of mortality in pH（7.35 group or PCO2≥50 mm Hg group （P（0.01）. And the mortalities of SCAP complicated with COPD, multilobar lung affectation in X-rays, multi-organ failure, breath rate≥30/min, WBC 10 × 10^9/L or ALB〈 30 g/L groups were obviously higher （P （0.05）. Conclusion Eight risk factors were also correlated with mortality of SCAP： arterial pH〈 7.35, PCO2≥50 mm Hg, with complication of ODPD, multilobar lung affectation in X-rays, multi-organ failure, breath rate≥30/min, WBC≥10 × 10^9/L and ALB〈30 g/L. Serial measurement of CPIS is valuable in evaluating the prognosis.
关键词
肺炎
社区获得性感染
危险因素
临床肺部感染评分
Pneumonia
Community-acquired infection
Risk factors
Clinical pulmonary infection score
