摘要
目的探讨社区获得性肺炎合并脓毒症患者的临床特征及死亡危险因素。方法回顾性分析了2015年1月—2021年10月入住中南大学湘雅三医院重症监护室的社区获得性肺炎合并脓毒症患者资料共350例,对其基本特征、实验室结果及治疗等进行分析。结果社区获得性肺炎合并脓毒症患者非幸存组白细胞绝对值、中性粒细胞百分比、中性粒细胞绝对值、炎症指标、肝肾功能、凝血功能、心肌酶学、乳酸、序贯性器官衰竭评估评分等指标均高于幸存组。Logistics回归分析显示:呼吸频率、心率、平均动脉压、血氧饱和度、C反应蛋白、D-二聚体、乳酸、肌酐、淋巴细胞百分比可能是社区获得性肺炎合并脓毒症患者28 d独立死亡危险因素。受试者操作特征曲线显示:将以上指标联合用来进行患者死亡危险的预测时,具有最佳敏感性、特异性和最大曲线下面积,优于单个变量预测的价值。结论社区获得性肺炎合并脓毒症非幸存组患者具有更为严重的炎症反应及器官功能损伤。呼吸频率、心率、平均动脉压、血氧饱和度、C反应蛋白、D-二聚体、乳酸、肌酐、淋巴细胞百分比等指标是社区获得性肺炎合并脓毒症患者死亡独立危险因素,当其联合分析时具有更优的预测预后价值。
Objective To investigate the clinical characteristics and death risk factors of patients with community acquired pneumonia and sepsis.Methods Data of 350 patients with community-acquired pneumonia and sepsis admitted to the Intensive Care Unit of Third Xiangya Hospital of Central South University from January 2015 to October 2021 were retrospectively analyzed,and their basic characteristics,laboratory results and treatment were analyzed.Results The absolute value of white blood cell,neutrophil ratio,absolute value of neutrophil,inflammatory index,liver and kidney function,coagulation function,cardiac enzymology,lactic acid and sequential organ failure evaluation score of patients with community acquired pneumonia sepsis in the non-survival group were higher than those in the survival group.Logistic regression analysis showed that respiratory rate,heart rate,mean arterial pressure,blood oxygen saturation,C-reactive protein,D-dimer,lactic acid,creatinine and lymphocyte ratio may be independent risk factors for 28-day death in patients with community-acquired pneumonia and sepsis.The receiver operating characteristic curve shows that the combination of the above indicators to predict the risk of death of patients has the best sensitivity,specificity and maximum area under the curve,which is superior to the prediction value of individual variables.Conclusions Patients in the non-survivor group of community-acquired pneumonia sepsis had more severe inflammatory response and organ function impairment.Respiratory rate,heart rate,mean arterial pressure,blood oxygen saturation,C-reactive protein,D-dimer,lactic acid,creatinine,lymphocyte ratio and other indicators are independent risk factors for death of patients with community-acquired pneumonia and sepsis,which have better prognostic value when combined.
作者
李彭
谢丽华
孙圣华
刘纯
LI Peng;XIE Lihua;SUN Shenhua;LIU Chun(Department of Respiratory and Critical Diseases,Xiangya Third Hospital,Central South University,Changsha,Hunan 410000,P.R.China)
出处
《中国呼吸与危重监护杂志》
CAS
CSCD
北大核心
2022年第4期260-268,共9页
Chinese Journal of Respiratory and Critical Care Medicine
关键词
社区获得性肺炎
脓毒症
临床特征
危险因素分析
Community acquired pneumonia
sepsis
clinical features
risk factor analysis
作者简介
通信作者:谢丽华,Email:xyelyhua@163.com;通信作者:孙圣华,Email:sunsh311@hotmail.com
