[嗜肺军团菌所致重症社区获得性肺炎合并急性呼吸衰竭：34例临床特征及预后]
[Severe community-acquired pneumonia caused by Legionella pneumophila with acute respiratory failure: clinical characteristics and prognosis of 34 cases].
作者信息
He C W, Tang X, Sun B, Li X Y, Wang R, Li Y, Chu H W, Wang L, Tong Z H
机构信息
Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University; Beijing Institute of Respiratory Medicine; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders; Beijing Engineering Research Center for Diagnosis and Treatment of Respiratory and Critical Care Medicine (Beijing Chaoyang Hospital), Beijing 100020, China (now working in the Beijing Prevention and Treatment Hospital of Occupational Disease for Chemical Industry, Beijing 100093, China).
Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University; Beijing Institute of Respiratory Medicine; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders; Beijing Engineering Research Center for Diagnosis and Treatment of Respiratory and Critical Care Medicine (Beijing Chaoyang Hospital), Beijing 100020, China.
出版信息
Zhonghua Jie He He Hu Xi Za Zhi. 2020 Jul 12;43(7):557-563. doi: 10.3760/cma.j.cn112147-20200114-00023.
To describe the clinical characteristics and treatment of severe community-acquired pneumonia(SCAP) caused by Legionella pneumophila with acute respiratory failure and to analyze the risk factors for mortality. From October 2011 to October 2019, 34 patients were diagnosed with SCAP caused by Legionella pneumophila with acute respiratory failure.There were 25 males and 9 females, aged from 17 to 82 years, with a median age of 61 (48, 69) years. According to the prognosis, the patients were divided into a survival group and a death group for comparative analysis.The survival group included 24 patients, 17 males and 7 females, with a median age of 65 (55, 70) years. There were 10 cases in the death group, 8 males and 2 females, with a median age of 53 (50, 58) years. Multivariable logistic regression analysis was used for risk factors of ICU mortality. The median time of admission to ICU was 7 (5, 11) days, the median time of stay in RICU was 12 (7, 22) days, and the PaO(2)/FiO(2) was 134 (91, 216) mmHg(1 mmHg=0.133 kPa). Ten patients died during ICU hospitalization, with a mortality of 29%. Sequential organ failure assessment (SOFA) of death group was 9 (7, 12), which was significantly higher than that of the survival group [4 (3, 8)], 0.018. The time from onset of pneumonia symptoms to initiation of targeted treatment of the death group was 10 (7, 14) d, which was significantly longer than that of the survival group of [4 (3, 7) d], 0.019. Multivariable logistic regression analysis showed that SOFA score (1.461, 95 1.041-2.051, 0.028) and the time from onset of pneumonia symptoms to initiation of targeted treatment (1.293, 95 1.029-1.625, 0.027) were independent risk factors for hospital mortality. The ICU mortality of severe legionella pneumonia was high. Critical organ dysfunctions and delayed initial targeted treatment were related with the increase of ICU mortality.
描述嗜肺军团菌所致重症社区获得性肺炎（SCAP）合并急性呼吸衰竭的临床特征及治疗方法，并分析死亡危险因素。2011年10月至2019年10月，34例患者被诊断为嗜肺军团菌所致SCAP合并急性呼吸衰竭。其中男性25例，女性9例，年龄17～82岁，中位年龄61（48，69）岁。根据预后将患者分为存活组和死亡组进行对比分析。存活组24例，男性17例，女性7例，中位年龄65（55，70）岁。死亡组10例，男性8例，女性2例，中位年龄53（50，58）岁。采用多因素logistic回归分析ICU死亡的危险因素。入住ICU的中位时间为7（5，11）天，入住RICU的中位时间为12（7，22）天，PaO₂/FiO₂为134（91，216）mmHg（1 mmHg = 0.133 kPa）。10例患者在ICU住院期间死亡，死亡率为29%。死亡组序贯器官衰竭评估（SOFA）为9（7，12），显著高于存活组[4（3，8）]，P = 0.018。死亡组从肺炎症状出现到开始针对性治疗的时间为10（7，14）天，显著长于存活组的[4（3，7）天]，P = 0.019。多因素logistic回归分析显示，SOFA评分（1.461，95%CI 1.041 - 2.051，P = 0.028）以及从肺炎症状出现到开始针对性治疗的时间（1.293，95%CI 1.029 - 1.625，P = 0.027）是医院死亡的独立危险因素。重症军团菌肺炎的ICU死亡率较高。关键器官功能障碍和初始针对性治疗延迟与ICU死亡率增加有关。
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