摘要
目的:探讨慢性阻塞性肺疾病(COPD)并发社区获得性肺炎老年患者病原菌分布、影像学特点及并发呼吸衰竭的相关因素。方法:选取COPD并发社区获得性肺炎患者154例作为观察组,同时选取单纯COPD患者154例作为对照组,比较两组病原菌、影像学特征差异,同时分析观察组合并和未合并呼吸衰竭患者临床资料差异。结果:观察组共检出病原菌93株,其中肺炎克雷伯杆菌、大肠埃希菌、肺炎链球菌和非典型致病菌,分别占16.13%、13.98%、12.90%和12.90%。观察组片状浸润影、实变影和空洞比例分别为86.36%、20.78%和14.94%,明显高于对照组(P<0.05)。观察组合并呼吸衰竭患者年龄≥70岁、APACHEⅡ评分>15分、血清白蛋白<30g/L、COPD病程>10年比例分别为72.86%、65.71%、64.29%和72.86%,明显高于未合并呼吸衰竭患者(P<0.05)。Logistic回归分析,结果显示:年龄、APACHEⅡ评分、血清白蛋白、COPD病程是患者发生呼吸衰竭的影响因素(P<0.05)。结论:COPD并发社区获得性肺炎患者肺炎克雷伯杆菌感染率高,两者影像学特征有明显差异;COPD并发社区获得性肺炎患者发生呼吸衰竭受患者年龄、APACHEⅡ评分等因素影响。
Objective:To investigate the pathogen distribution,imaging characteristics and related factors of respiratory failure in elderly patients with COPD complicated with community acquired pneumonia.Methods:A total of 154 patients with COPD complicated with community acquired pneumonia who were treated were selected as the observation group,while 154 patients with simple COPD were selected as the control group,the differences in pathogenic bacteria and imaging characteristics between the two groups were compared,and the differences in clinical data between the observation group and patients without respiratory failure were analyzed.Results:93 strains of pathogenic bacteria were detected in the observation group,including Klebsiella pneumoniae,Escherichia coli,Streptococcus pneumoniae and atypical pathogens,accounting for 16.13%,13.98%,12.90%and 12.90%respectively.The proportion of lamellar infiltration shadow,consolidation shadow and cavity in the observation group was 86.36%,20.78%and 14.94%respectively,which was significantly higher than that in the control group(P<0.05).The proportion of≥70 years old,APACHEⅡscore>15,serum albumin<30g/L,COPD course>10 years in patients with combined respiratory failure was 72.86%,65.71%,64.29%and 72.86%,(P<0.05).Logistic showed that age,APACHEⅡ,serum albumin and COPD course were the influencing factors of respiratory failure(P<0.05).Conclusion:Patients with COPD complicated by community-acquired pneumonia have a high rate of Klebsiella pneumoniae infection,with significant differences in imaging features between the two;the development of respiratory failure in patients with COPD complicated by community-acquired pneumonia is influenced by factors such as patient age and APACHEⅡscore.
作者
康林
王焱莘
祝莹
高芸
黄瑾
KANG Lin;WANG Yanxin;ZHU Ying(Ya'an People's Hospital,Sichuan Ya'an 625000,China)
出处
《河北医学》
CAS
2023年第7期1196-1201,共6页
Hebei Medicine
基金
四川省卫生和计划生育委员会科研课题,(编号:17PJ034)
四川省医学科研青年创新课题,(编号:Q16081)。
