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目的了解重症社区获得性肺炎(CAP)死亡患者的临床特征和死亡预测因素。方法回顾性收集2009年1月-2012年12月143例重症CAP患者的临床资料,并根据患者是否死亡,将其分成存活组和死亡组,比较两组患者的临床特征和实验室检测结果,并利用多因素回归分析了解可预测患者死亡结局的因素。结果 118例患者存活,25例患者死亡,病死率为17.5%。存活组和死亡组合并基础疾病的患者分别为57例(48.3%)和25例(100.0%),差异有统计学意义(P<0.05);在合并基础疾病的患者中,死亡组合并3种及以上疾病的患者数量显著多于存活组[76.0%(19/25)、22.8%(13/57),P<0.05];死亡组患者气管插管发生率显著高于存活组患者[84.0%(21/25)、33.1%(39/118),P<0.05];死亡组入院前动脉血p H值(7.15±0.52、7.42±0.17,P<0.05)、碳酸氢根离子浓度[(18.07±6.25)、(25.07±5.44)mmol/L,P<0.05]、动脉血氧分压(PaO2)[(58.92±35.18)、(85.92±32.19)mm Hg(1 mm Hg=0.133 k Pa),P<0.05]以及氧合指数(PaO2/FiO2)[(118.23±98.02)、(260.17±151.22)mm Hg,P<0.05]均低于存活组患者。多因素logistic回归显示合并基础疾病数量[OR=0.202,95%CI(0.198,0.421),P=0.003]、入院前Pa O2[OR=1.203,95%CI(1.193,1.294),P=0.011]和Pa O2/Fi O2[OR=0.956,95%CI(0.927,0.971),P=0.008]均是重症CAP患者死亡的独立预测因素。结论重症CAP死亡患者入院前病情常较重,基础疾病数量和入院前Pa O2对于重症CAP具有较高的死亡预测价值。
Objective To investigate the clinical characteristics and predictors of mortality in patients with severe community-acquired pneumonia (CAP) death. Methods The clinical data of 143 patients with severe CAP from January 2009 to December 2012 were retrospectively collected. According to whether the patients died or not, the patients were divided into survival group and death group. The clinical characteristics and laboratory test results were compared between the two groups. Multivariate regression analysis was used to understand the factors that predict the patient’s death outcome. Results 118 patients survived, 25 patients died, the fatality rate was 17.5%. There were 57 cases (48.3%) and 25 cases (100.0%) in the survival group and the death group with the underlying diseases respectively, the difference was statistically significant (P <0.05). Among the patients with underlying diseases, the death groups were combined with 3 (P0.05). The incidence of tracheal intubation in the death group was significantly higher than that in the survivor group (84.0%). The incidence of tracheal intubation in the death group was significantly higher than that in the survival group (76.0%, 19/25, 22.8%, 13/57) (21/25), 33.1% (39/118), P <0.05]. Before treatment, the values of p H in arterial blood before death in hospitalization group were 7.15 ± 0.52, 7.42 ± 0.17, P <0.05, (25.07 ± 5.44) mmol / L, P <0.05], PaO2 (58.92 ± 35.18), (85.92 ± 32.19) mm Hg (1 mm Hg = 0.133 kPa) P <0.05] and oxygenation index (PaO2 / FiO2) [(118.23 ± 98.02), (260.17 ± 151.22) mm Hg, P <0.05] were lower than those in survivors. Multivariate logistic regression showed that there was a significant increase in the number of underlying diseases (OR = 0.202, 95% CI 0.198, 0.41 1, P 0.003) and pre-admission Pa O2 [OR 1.203, 95% CI 1.193, And Pa O2 / Fi O2 [OR = 0.956, 95% CI (0.927, 0.971), P = 0.008] were all independent predictors of death in critically ill patients with CAP. Conclusions The patients with severe CAP may die before admission. The number of basic diseases and Pa O2 before admission may have higher predictive value for mortality in critically ill patients.