【作者】 李伟文；

【导师】 周建英；

【作者基本信息】 浙江大学 ， 内科学， 2012， 硕士

【摘要】 目的：分析重症肺炎患者的临床特点、危险因素、治疗、预后,并在此基础上分析预后相关因素,以期提高对重症肺炎的认识。对重症肺炎患者的预后进行预测,利于临床治疗,降低其死亡率。方法：对2011年1月至2011年12月在浙江大学医学院附属第一医院诊断为重症肺炎的60例病例的临床资料进行回顾性分析。根据预后情况分为死亡组和生存组。先后以单因素及Logistic多元回归法对其预后相关因素进行分析。结果：2011年1月至2011年12月共收集到重症肺炎60例,30天内死亡21例,生存组39例,死亡组21例,30天死亡率达35%。60例重症肺炎患者中CAP32例,HAP24例,HCAP4例。其中51例(85%)伴有基础疾病；53例(88.3%)伴有并发症,41例(68.3%)入院前使用抗生素。单因素分析显示生存组与死亡组在入院前抗生素使用、化疗、感染性休克、败血症、气管插管、入住ICU、肌酐水平、血小板计数、血清钠水平这九类指标上差异具有统计学意义(P<0.05),多因素Logistic回归分析显示入院前抗生素使用、患败血症和气管插管是重症肺炎的死亡影响因素(OR值分别为0.07、16.66、19.2,P<0.05)。结论：调查统计分析提示重症肺炎其病死率高,伴有基础疾病的比例高。感染性休克、败血症、气管插管、入住ICU、高肌酐水平、血小板计数、血清钠水平是重症肺炎患者死亡的独立危险因素,而入院前使用抗生素、败血症和气管插管与重症肺炎患者死亡存在一定的相关性。更多还原

【Abstract】 Objective:To analysis of severe pneumonia in patients with the clinical characteristics, risk factors, treatment, prognosis and and on this basis, in order to get a better understand of severe pneumonia and conducive to clinical treatment, to reduce the mortality.Methods:The episodes of severe pneumonia from January2011to December2012in the First Affiliated Hospital, College of Medicine, Zhejiang University were retrospectively analyzed. According to the prognosis is divided into the group of death and survival. Risk factors associated with mortality were assessed by univariate and multivariate analysis.Results:60cases of severe pneumonia were collected from January2011to December2011, Among the60patients of severe pneumonia,21cases were finally dead in30days, the30-day mortality is35%.There are85%of the patients accompanied with underlying diseases;88.3%with complications,68.3%with pre-hospital utilization of antibiotics.Univariate analysis showed that nine categories of indicators, pre-hospital use of antibiotics, chemotherapy, septic shock, sepsis, tracheal intubation, ICU admission, creatinine levels, platelet count, serum sodium level, were statistically different between survival group and death group (P<0.05). The Logistic regression analysis displayed the pre-hospital use of antibiotics, sepsis, tracheal intubation were associated with mortality.(OR values:0.07,16.66、19.2respectively, all P<0.05).Conclusions:Investigation and statistical analysis suggesting the mortality rate of severe patients with severe pneumonia is very high, High proportion of underlying disease. pre-hospital use of antibiotics, chemotherapy, septic shock, sepsis, tracheal intubation, ICU admission, creatinine levels, platelet count, serum sodium level were independent risk factors of mortality, pre-hospital use of antibiotics, sepsis, tracheal intubation were associated with mortality.更多还原