摘要
目的分析重症病毒性肺炎患者临床特征及预后影响因素。方法比较2014年1月—2020年1月航天中心医院重症医学科收治的95例重症病毒性肺炎生存和死亡患者病原体及临床特征差异。结果67例为单纯病毒感染,28例为病毒-细菌/真菌混合感染,住院期间全因病死率22.1%,死亡患者多为甲流或其混合感染,呼吸困难(P=0.011),收缩压偏低(P=0.003)、舒张压偏低(P=0.012)和意识改变(P<0.001),病情更严重(APACHEⅡP<0.001;急性肺损伤评分P<0.001;氧合指数P<0.001),淋巴细胞计数(P=0.003),白蛋白降低(P=0.002),D-二聚体升高(P<0.001),且存在免疫缺陷(P=0.026)。Logistic回归提示病毒-细菌/真菌混合感染为影响预后的独立危险因素(OR=5.727,95%CI 1.247~46.304,P=0.025)。结论甲流病毒感染、免疫缺陷、淋巴细胞持续降低,病情严重且合并脏器功能损伤,是病毒肺炎发展为重症及引起死亡的原因,病毒-细菌/真菌混合感染是影响预后的独立危险因素。
Objective To assess the clinical features and prognostic factors of patients with severe viral pneumonia admitted to the intensive care unit. Methods The clinical data of 95 patients with severe viral pneumonia admitted in our ICU were analyzed retrospectively. The clinical characteristics of 64 survivors were compared with 21 non-survivors from 2014 to 2020. The prognostic factors of viral pneumonia were also investigated. Results Of the 95 patients, 67 were virus infection, and 28 were virus-bacterial/fungal mixed infection. The hospital mortality was 22.1%. Compared with survivors, most of non-survivors were influenza A virus infection and showed dyspnoea(P=0.011), lower systolic and diastolic pressure(P=0.003, P=0.012), changing of conscious state(P=0.000) and immunedeficiency(P=0.026) at admission. Multivariable Logistic regression analysis showed that virus-bacterial/fungal co-infection were independent risk factors for hospital mortality(OR=5.727, 95%CI 1.247~-46.304, P=0.025). Conclusion Influenza A virus, immunodeficiency, disease severity and severe organ failure are the main risk factors for the disease progress and prognosis. Virus-bacterial/fungal co-infection are independent risk factors for hospital mortality.
作者
刘音
杨竞铖
贺小旭
李周平
任丽丽
薛晓艳
LIU Yin;YANG Jing-cheng;HE Xiao-xu;LI Zhou-ping;REN Li-li;XUE Xiao-yan(Department of Critical Care Medicine,Aerospace Center Hospital(Aerospace Clinical Medical College of Peking University),Beijing 100049,China;Institute of Pathogen Biology,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China)
出处
《临床肺科杂志》
2022年第10期1463-1467,共5页
Journal of Clinical Pulmonary Medicine
基金
航天医科科研基金资助项目(NO.2020YK03)
传染病重大专项课题(NO.2017zx10103004)。
关键词
病毒性肺炎
重症
临床特征
预后
viral pneumonia
severe cases
clinical features
prognosis
