结缔组织病并发重症肺炎39例临床病原学分析(1)
[摘要] 目的 研究入住ICU的結缔组织病(CTDs)并发重症肺炎患者的病原学特点，探讨其与临床表征和预后转归的关系，深化CTDs并发重症肺炎的临床认识。 方法 回顾2011年1月～2016年12月我院ICU收治的CTDs并发重症肺炎病例。收集患者病历资料，对比分析治疗成功与治疗失败患者的临床及微生物学特点。 结果 纳入39例CTDs并发重症肺炎患者，获取阳性病原学结果58份。治疗成功24例(61.5%)，治疗失败15例(38.5%)，其中死亡10例(25.6%)。肠道革兰阴性杆菌26例(44.8%)、非发酵革兰阴性杆菌12例(20.7%)、革兰阳性球菌7例(12.1%)、真菌感染9例(15.5%)、病毒感染4例(6.9%)。与治疗成功患者比较，治疗失败者APACHEⅡ评分更高(23分vs 19分，P=0.041)；罹患间质性肺病(73.3% vs 37.5%，P=0.048)、使用糖皮质激素(100.0% vs 70.8%，P=0.031)、有创机械通气(60.0% vs 20.8%，P=0.019)及耐药微生物感染比例更高；混合感染(≥2种病原微生物)更多见(66.7% vs 25.0%，P=0.018)。 结论 入住ICU的CTDs并发重症肺炎患者治疗失败风险高，合并间质性肺病、长期使用糖皮质激素、有创机械通气、耐药病原菌感染与不良预后有关。
[关键词] 结缔组织病；肺炎；重症；病原学
[中图分类号] R563.1；R593.2 [文献标识码] A [文章编号] 1673-9701(2018)01-0004-04
Clinicopathological analysis of 39 cases of connective tissue diseases complicated with severe pneumonia
WU Xiaomai1 LIN Ling1 CHEN Qiuying2 CUI Ke3
1.Department of Respiratory Medicine， Taizhou Hospital of Zhejiang Province， Linhai 317000， China； 2.Department of Surgery， Taizhou Hospital of Zhejiang Province， Linhai 317000， China； 3.Department of Intensive Medicine， Taizhou Hospital of Zhejiang Province， Linhai 317000， China
[Abstract] Objective To study the etiological characteristics of patients with connective tissue diseases (CTDs) complicated with severe pneumonia in ICU， to explore its relationship with clinical features and prognosis， and to deepen the clinical understanding of CTDs complicated with severe pneumonia. Methods Cases with CTDs complicated with severe pneumonia who were admitted to ICU in our hospital from January 2011 to December 2016 were retrospectively analyzed. Patients' medical records were collected， and the clinical and microbiological characteristics of patients with successful treatment and failed treatment were compared and analyzed. Results 39 cases of CTDs complicated with severe pneumonia were included， and 58 pieces of results of positive pathogens were obtained. Successful treatment was in 24 cases (61.5%)， treatment failure was in 15 cases (38.5%)， and death was in 10 cases (25.6%). Intestinal gram-negative bacilli were in 26 cases (44.8%)， non-fermented gram-negative bacilli were in 12 cases (20.7%)， gram-positive cocci were in 7 cases (12.1%)， fungal infection was in 9 cases (15.5%)， and virus infection was in 4 cases (6.9%). Compared with the patients with successful treatment， the APACHE Ⅱ score was higher in the patients with failed treatment (23 points vs 19 points， P=0.041)， the proportions of interstitial lung disease(73.3% vs 37.5%， P=0.048)， administration of glucocorticoids (100.0% vs 70.8%， P=0.031)， invasive mechanical ventilation (60.0% vs 20.8%， P=0.019)， drug-resistant microbial infection were higher. Mixed infection(≥2 kinds of pathogenic microorganisms) was more common (66.7% vs 25.0%， P=0.018). Conclusion The patients with CTDs complicated with severe pneumonia who are admitted to ICU has a higher risk of treatment failure， which are correlated with the complications of interstitial lung disease， long-term use of glucocorticoids， invasive mechanical ventilation， drug-resistant pathogen infection and poor prognosis., http://www.100md.com(吴小脉 林玲 陈秋英 崔可)
[关键词] 结缔组织病；肺炎；重症；病原学
[中图分类号] R563.1；R593.2 [文献标识码] A [文章编号] 1673-9701(2018)01-0004-04
Clinicopathological analysis of 39 cases of connective tissue diseases complicated with severe pneumonia
WU Xiaomai1 LIN Ling1 CHEN Qiuying2 CUI Ke3
1.Department of Respiratory Medicine， Taizhou Hospital of Zhejiang Province， Linhai 317000， China； 2.Department of Surgery， Taizhou Hospital of Zhejiang Province， Linhai 317000， China； 3.Department of Intensive Medicine， Taizhou Hospital of Zhejiang Province， Linhai 317000， China
[Abstract] Objective To study the etiological characteristics of patients with connective tissue diseases (CTDs) complicated with severe pneumonia in ICU， to explore its relationship with clinical features and prognosis， and to deepen the clinical understanding of CTDs complicated with severe pneumonia. Methods Cases with CTDs complicated with severe pneumonia who were admitted to ICU in our hospital from January 2011 to December 2016 were retrospectively analyzed. Patients' medical records were collected， and the clinical and microbiological characteristics of patients with successful treatment and failed treatment were compared and analyzed. Results 39 cases of CTDs complicated with severe pneumonia were included， and 58 pieces of results of positive pathogens were obtained. Successful treatment was in 24 cases (61.5%)， treatment failure was in 15 cases (38.5%)， and death was in 10 cases (25.6%). Intestinal gram-negative bacilli were in 26 cases (44.8%)， non-fermented gram-negative bacilli were in 12 cases (20.7%)， gram-positive cocci were in 7 cases (12.1%)， fungal infection was in 9 cases (15.5%)， and virus infection was in 4 cases (6.9%). Compared with the patients with successful treatment， the APACHE Ⅱ score was higher in the patients with failed treatment (23 points vs 19 points， P=0.041)， the proportions of interstitial lung disease(73.3% vs 37.5%， P=0.048)， administration of glucocorticoids (100.0% vs 70.8%， P=0.031)， invasive mechanical ventilation (60.0% vs 20.8%， P=0.019)， drug-resistant microbial infection were higher. Mixed infection(≥2 kinds of pathogenic microorganisms) was more common (66.7% vs 25.0%， P=0.018). Conclusion The patients with CTDs complicated with severe pneumonia who are admitted to ICU has a higher risk of treatment failure， which are correlated with the complications of interstitial lung disease， long-term use of glucocorticoids， invasive mechanical ventilation， drug-resistant pathogen infection and poor prognosis., http://www.100md.com(吴小脉 林玲 陈秋英 崔可)