108例重症社区获得性肺炎患者预后相关危险因素分析

摘要

Objective To investigate the risk factors associated with the mortality of patients with severe pneumonia . Methods 108 patients with severe community-acquired pneumonia were divided into the death group and the survival group according to their prognosis. Univariate analysis ( chi-square test and rank sum test) and mult-ivariate Logistic regression were used for statistics analysis. Results The mortality was 45. 3% (49/108) in all 108 patients with severe pneumonia. Univariate analysis suggested that age, number of basic diseases, multiple organ dys-function, plasma albumin levels, serum procalcitonin, low oxygenation index and blood lactate levels might be associ-ated with the prognosis of severe pneumonia, while sex, respiratory frequency, white blood cell count, blood glucose, total bilirubin, long-term lie in bed, systolic pressure and other factors had nothing to do with the prognosis. Multi-variable logistic regression model analysis showed that older age (≥83. 5 years), blood lactate levels (≥5. 06 mmol/L), organ damage quantity and low oxygenation index ( <200 mmHg) were the independent risk factors for severe community-acquired pneumonia. Conclusion Older age (≥83. 5 years), blood lactate levels (≥5. 06 mmol/L) and organ damage quantity and low oxygenation index ( <200 mmHg) are the independent risk factors for severe community-acquired pneumonia.%目的：探讨重症社区获得性肺炎死亡相关危险因素，为临床救治提供帮助。方法收集入住呼吸科及综合ICU的重症社区获得性肺炎患者108例，根据预后情况分为死亡组和存活组，通过单因素分析和多因素logistic回归分析，筛选其死亡相关危险因素。结果108例重症社区获得性肺炎病死率为45．3%(49/108)。单因素分析提示年龄、基础疾病数量、多器官功能障碍、血浆白蛋白水平、血清降钙素原、低氧合指数及血乳酸浓度等因素，可能与重症社区获得性肺炎预后相关( P<0．05)，而性别、呼吸频率、血白细胞计数、血糖、总胆红素、长期卧床、收缩压等因素可能与预后无关( P>O．05)；多因素logistic回归模型分析显示年龄≥83．5岁、血乳酸≥5．06 mmol/L、器官功能损害数量多以及氧合指数<200 mmHg等可能为重症社区获得性肺炎死亡的独立危险因素。结论高龄(≥83．5岁)、多器官功能障碍、低氧合指数(<200 mmHg)及高血乳酸(≥5．06 mmol/L)可能为重症社区获得性肺炎死亡的主要危险因素。