目的 了解广东地区aids并发重症肺炎的病原分布特点和预后影响因素.方法 以2005年1月至2008年12月广州市第八人民医院感染科收治的95例aids并发重症肺炎住院患者为研究对象.采用回顾性病例对照研究分析病原分布特点,根据不同预后将患者分为存活组和死亡组,并采用单因素和多因素logistic回归分析相关影响因素.结果 aids并发重症肺炎病原谱依次为肺孢子菌( 64/95,67.4％)、细菌(61/95,64.2％)、真菌(50/95,52.6％)、结核分枝杆菌(27/95,28.4％)、巨细胞病毒( 25/95,26.3％),其中80例(80/95,84.2％)为两种以上病原感染,15例(15/95,15.8％)为单一病原感染.logistic回归分析显示,需要机械通气、高ldh水平、有严重基础疾病是aids并发重症肺炎死亡的危险因素,高白蛋白水平是aids并发重症肺炎的预后保护性因素.结论 aids并发重症肺炎病原以肺孢子菌、细菌、真菌感染为主,多种病原感染多见.
abstract：
objective to investigate the pathogens and prognostic factors of aids-associated severe pneumonia. methods clinical data were collected from 95 patients with aids-associated severe pneumonia admitted to guangzhou no. 8 people' s hospital from january 2005 to december 2008. the pathogens of pulmonary infections were investigated. univariate analysis and multivariate logistic regression analysis were performed to study the relationships between the outcome and influencing factors. results the most prevalent pathogen was pneumocystis jirovecii (64/95, 67.4％ ), followed by bacteria (61/95, 64.2％ ),fungi ( 50/95, 52. 6％ ), mycobacterium tuberculosis ( 27/95, 28. 4％ ) and cytomegalovirus ( cmv ) (25/95, 26.3％ ). among 95 cases, monocontamination was detected in 15 cases ( 15.8％ ), while mixed infection in 80 cases (84. 2％ ). logistic regression analysis showed that mechanical ventilation, higher serum lactic dehydrogenase (ldh) level and severe underlying diseases were risk factors for the death of aids-ass
目的分析重症社区获得性肺炎(SCAP)合并急性呼吸窘迫综合征(ARDS)患者的肺部超声特点,为临床诊治提供参考。方法选择重症医学科(ICU)收治的SCAP中符合柏林诊断标准的ARDS患者32例,其中存活17例(存活组),死亡15例(死亡组),轻中度ARDS 24例(轻中度ARDS组),重度ARDS 8例(重度ARDS组),低呼气末正压(PEEP)组(PEEP<8 cm H_2O)15例,高PEEP组(PEEP≥8 cm H_2O)17例,临床肺部感染评分(CPIS)≤6分组10例(CPIS≤6分组),CPIS>6分组22例(CPIS>6分组)。收集患者入院时的性别、年龄、氧合指数(OI)、PEEP、急性生理与慢性健康状况评分(APACHEⅡ)和CPIS等临床指标。在患者入院时行肺部超声检查和评分,分析肺部超声影像特点与临床指标的相关性。结果 32例患者肺部超声评分(LUS)(18.84±6.32)分,右肺超声评分(R-LUS)(9.75±3.25)分,左肺超声评分(L-LUS)(9.06±4.02)分。其中死亡患者、重度ARDS患者、高PEEP患者和CPIS>6分患者的LUS、R-LUS、L-LUS均分别明显高于存活患者、轻中度ARDS患者、低PEEP患者和CPIS≤6分患者,差异均有统计学意义(P<0.05);而R-LUS与L-LUS比较差异无统计学意义(P>0.05)。主要差异在于前者正常肺通气区(A征象)明显减少,而重度肺组织失气化区(B3征象)明显增多;双肺重力依赖区超声评分明显高于非重力依赖区(P<0.05);LUS与OI(r=-0.530,P=0.002)呈显著负相关,与PEEP(r=0.554,P=0.001)、APACHEⅡ评分(r=0.497,P=0.004)、CPIS(r=0.626,P=0.000)均呈显著正相关,以A和B3征象与临床指标的相关性最好。结论肺部超声能实时评估肺部病变性质、范围和病情严重程度,可为SCAP致ARDS患者的临床诊治提供重要参考依据。
