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目的分析无反应肺炎的临床危险因素,以提高临床对无反应性肺炎的认识。方法收集2013年9月-2015年9月间贵州省人民医院呼吸与危重症医学科51例无反应肺炎临床资料,随机选取同期住院的50例正常反应肺炎住院患者作为对照组。对2组的危险因素、临床表现、影像学进行统计学分析。结果单因素分析提示,合并高龄(>65岁)、慢性阻塞性肺疾病、低血清白蛋白水平、慢性肾功能不全、脑血管疾病患者无反应肺炎发生率高于肺炎初始治疗有效患者(P<0.05)。多因素Logistic回归分析显示慢性阻塞性肺疾病病史、低血清白蛋白水平、慢性肾功能不全病史、脑血管疾病是无反应肺炎的独立危险因素。2组在起始临床症状(发热、胸闷气短),实验室检查(WBC计数、N%、PCT、血沉、CRP、胸部影像多肺叶浸润、胸腔积液)差异有统计学意义(P<0.05)。结论慢性基础疾病和特殊病原体感染是无反应肺炎的危险因素。无反应肺炎者初始治疗时往往炎性反应更重。多肺叶浸润及胸腔积液有助于提早识别无反应肺炎。
Objective To analyze the clinical risk factors of non-responsive pneumonia in order to improve the clinical understanding of non-responsive pneumonia. Methods The clinical data of 51 patients with unreacted pneumonia from September 2013 to September 2015 in Guizhou Provincial Department of Respiratory and Critical Care Medicine were collected and randomly selected from 50 hospitalized patients with normal reaction pneumonia as the control group. The risk factors, clinical manifestations and imaging of the two groups were statistically analyzed. Results Univariate analysis showed that the incidence of non-responsive pneumonia in patients with advanced age (> 65 years), chronic obstructive pulmonary disease, low serum albumin level, chronic renal insufficiency and cerebrovascular disease was higher than that of patients with initial treatment of pneumonia (P < 0.05). Multivariate logistic regression analysis showed that the history of chronic obstructive pulmonary disease, low serum albumin level, history of chronic renal failure, cerebrovascular disease were independent risk factors of non-responsive pneumonia. There were significant differences in the initial clinical symptoms (fever, shortness of breath and chest tightness), laboratory tests (WBC count, N%, PCT, ESR, CRP, pleural effusion and pleural effusion) . Conclusion Chronic basic disease and special pathogen infection are risk factors of non-responsive pneumonia. Inflammatory reactions are often more severe with initial treatment of non-responsive pneumonia. Multiple lobular infiltrates and pleural effusion help identify anaplastic pneumonia earlier.