临床易用性检验指标对成人社区获得性肺炎患者早期临床疗效的预测价值

摘要

Objective To explore the predictive value of easy-to-use clinical indicators on early efficacy of adult community-acquired pneumonia (CAP).Methods Clinical data of 230 adult patients with CAP from December 2012 to December 2014 in Affiliated Hospital of Chengdu University were analyzed retrospectively.All patients had anti-infective agents,oxygen inhalation,atomization,fluid infusion and supportive therapies.Patients who achieved stable stage after treatment were grouped as stable group;other patients (including dead cases in 72 h after admission) were grouped as unstable group.General data and easy-to-use clinical indicators were analyzed.Results There were 194 cases in stable group and 36 cases in unstable group.Ratios of male,disease time≥3 d and smoking had no significant differences between groups (P ＞ 0.05);ratio of age ＞ 65 years old in stable group was significantly lower than that in unstable group (P ＜ 0.05).With correction of age,ratios of pH ＜ 7.35 and urea nitrogen ＞ 7 mmol/L in stable group were significantly lower than those in unstable group[8.8％ (17/194) vs 27.8％ (10/36),16.5％ (32/194) vs 44.4％ (16/36)] (P ＜ 0.05).There were no significant differences of ratios of artcrial oxygen partial pressure ＜ 60 mmHg,white blood cell count ＜ 4 × 109/L or ＞ 20 × 109/L,hemoglobin＜90 g/L,hematocrit ＜ 30％,platelet count ＜ 100 × 109/L,albumin ＜ 25 g/L,serum sodium ＜130 mmol/L and blood glucose ＞ 13.9 mmol/L between groups(P ＞0.05).Conclusion The pH value and trrea nitrogen level are risk factors of early clinical stability of CAP;pH ＜ 7.35 and urea nitrogen ＞ 7 mmol/L suggest poor early clinical outcomes.%目的 探讨临床易用性检验指标对成人社区获得性肺炎(CAP)患者早期临床疗效的预测价值.方法 回顾性分析2012年12月至2014年12月成都大学附属医院呼吸科230例成人CAP患者的临床资料.给予成人CAP患者相应抗菌药物的抗感染治疗,并同时给予吸氧、雾化、化痰止咳和补液支持等治疗.将能够满足所有临床稳定性指标的患者纳入稳定组;将不能满足其中任意1条临床稳定性指标或者入院后72 h内死亡的患者纳入未稳定组.比较2组一般资料以及临床易用性检验指标情况.结果 稳定组患者194例,未稳定组患者36例.稳定组男性、发病时间≥3 d和吸烟比例与未稳定组比较,差异均无统计学意义(均P ＞0.05).稳定组年龄＞65岁比例低于未稳定组,差异有统计学意义(P＜0.05).校正年龄后,稳定组pH值＜7.35、尿素氮＞7.0 mmol/L比例低于未稳定组[8.8％ (17/194)比27.8％ (10/36)、16.5％ (32/194)比44.4％ (16/36)],差异均有统计学意义(均P＜0.05).稳定组动脉血氧分压＜60 mmHg(1 mmHg =0.133 kPa)、白细胞计数＜4×109/L或＞20×109/L、血红蛋白＜90 g/L、血细胞比容＜30％、血小板计数＜ 100×109/L、白蛋白＜25 g/L、血钠＜130 mmol/L、血糖＞13.9 mmol/L与未稳定组比较,差异均无统计学意义(均P＞0.05).结论 pH值及尿素氮是影响CAP患者早期临床稳定性的危险因素;pH值＜7.35及尿素氮＞7.0 mmol/L提示患者更易出现较差的早期临床治疗效果.