入住重症监护病房的肺炎旁胸腔积液病死率的危险因素分析

Analysis of Risk Factors for Mortality of Parapneumonic Pleural Effusion in Intensive Care Unit

摘要: 目的：为了比较入住重症监护室(intensive care unit, ICU)的肺炎旁胸腔积液(Parapneumonic pleural effusion, PPE)患者临床特征、实验室数据、病原菌分布及影响住院30天病死率的危险因素。方法：本研究为多中心回顾性观察性研究，包括2014.01.01~2014.12.31期间我国13个不同地区的多家医院住院(Community-acquired pneumonia, CAP)患者临床数据。筛选出入住ICU的并有胸腔积液的CAP患者，根据患者30天内有无死亡，分为生存组和死亡组，比较两组患者的临床资料、病原学特征、治疗、病死率。最后采用多因素分析影响患者的住ICU的30天病死率的危险因素。结果：270例PPE患者入住ICU，年龄中位数是74.0岁，男性164例(60.7%)。住院30天内生存患者207例(76.7%)，年龄中位数为72.0 (60.0~82.0)岁，死亡患者63例(23.3%)，年龄中位数为75.0 (61.0~84.0)岁，两组均男性偏多，死亡患者易出现意识改变，PO₂ < 60 mmHg，尿素氮≥7 mmol/L，并发症发生率高。入住ICU患者主要培养菌为肺炎克雷伯杆菌(9.6%)，其次是金黄色葡萄球菌(4.1%)；死亡患者机械通气率，并发症发生率，应用血管活性药物概率均高于生存组。多因素分析显示影响入住ICU的PPE患者30天病死率的危险因素为尿素氮≥7 mmol/L (OR 3.102, 95% CI 1.220~7.887)，PO₂ < 60 mmHg (OR 2.634, 95% CI 1.100~6.309)，应用血管活性药物(OR 7.239, 95% CI 2.999~17.475)，脑卒中(OR 6.548, 95% CI 1.211~35.407)。结论：影响入住ICU的PPE患者30天病死率的危险因素为尿素氮>7 mmol/L，PO₂ < 60 mmHg，应用血管活性药物，出现脑卒中；临床医生应该注意识别患者危险因素，及时采取合理的治疗措施，降低患者病死率。

Abstract: Objective: To compare the clinical characteristics, laboratory data, pathogenic bacteria distribution and risk factors for 30-day mortality of patients with Parapneumonic pleural effusion (PPE) admitted to intensive care units (ICU). Method: This is a multicenter retrospective observational study, including clinical data of community-acquired pneumonia (CAP) patients hospitalized in hospitals in 13 different regions of China during 2014.01.01 - 2014.12.31. The CAP patients admitted to the ICU with pleural effusion were screened into survival group and death group according to whether the patients died within 30 days. The clinical data, etiological characteristics, treatment and fatality rate of the two groups were compared. Finally, a multivariate analysis was performed to determine the risk factors affecting the 30-day fatality rate. Result: There were 270 PPE patients admitted to ICU with a median age of 74.0 years and 164 males (60.7%). 207 patients (76.7%) survived within 30 days of hospitalization, with a median age of 72.0 (60.0 - 82.0) years; 63 patients (23.3%) died, with a median age of 75.0 (61.0 - 84.0) years. Both groups had more males, and the patients who died were prone to consciousness changes, PO₂ < 60 mmHg, urea nitrogen ≥ 7 mmol/L, and a high incidence of complications. The main culture bacteria of ICU patients were Klebsiella pneumoniae (9.6%), followed by Staphylococcus aureus (4.1%). The rate of mechanical ventilation, complication rate and application of vasoactive agents in patients with death were higher than those in the survival group. Multivariate analysis showed that the risk factors for 30-day mortality of PPE patients admitted to ICU were urea nitrogen ≥ 7 mmol/L (OR 3.102, 95% CI 1.220 - 7.887), PO₂ < 60 mmHg (OR 2.634, 95% CI 1.100 - 6.309), application of vasoactive agents (OR 7.239, 95% CI 2.999 - 17.475), stroke (OR 6.548, 95% CI 1.211 - 35.407). Conclusion: The risk factors affecting 30-day mortality of patients with PPE admitted to ICU are urea nitrogen ≥ 7 mmol/L, PO₂ < 60 mmHg, vasoactive drugs, and stroke. Clinicians should pay attention to identify the risk factors of patients and take reasonable treatment measures in time to reduce the mortality of patients.