影响老年重症社区获得性肺炎预后危险因素的回顾性分析
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摘要
目的：通过收集我院近十年以来的老年重症社区获得性肺炎患者的临床资料,回顾性分析我院老年重症社区获得性肺炎的临床特征,并探讨影响预后的相关因素,为进一步提高临床治疗效果提供参考依据。方法：收集我院2000年1月-2010年1月60岁以上的重症社区获得性肺炎患者117例,根据临床病史资料记录患者基本信息、生命体征、总住院天数,入住ICU的情况、既往各系统疾病及手术史；并且记录起病早期的临床症状,入院后的实验室检查以及影像学表现；回顾性分析患者的临床资料,采用描述性研究方法对所收集病例的一般临床资料进行分析。用logistic回归进行多因素分析的方法对老年SCAP患者的基本资料进行比较,有意义的因素进入循环中。结果：经综合治疗措施(包括抗感染、辅助呼吸治疗、免疫治疗、支持治疗以及痰液引流等)后,其中58例预后佳(好转),59例预后差(死亡,包括经治疗后无好转放弃治疗,出院后经电话随访已死亡的患者)。logistic回归方程结果显示影响老年人重症社区获得性肺炎预后的危险因素为人工气道、有基础疾病、多脏器功能衰竭、呼吸性酸中毒、低蛋白血症、低钠血症、年龄。结论：应重视危险因素对预后的影响,动态观察各项指标,对临床预防和治疗提供参考,及时、正确处理,改善患者病情,降低死亡率,提高治疗成功率。
Objective:our hospital nearly a decade older patients with severe community-acquired pneumonia clinical data, reviewed in our hospital of severe community-acquired pneumonia clinical features and prognostic factors of influence, in order to further improve the clinical Provide the reference treatment. Methods:our hospital in January 2000-2010 on January 60 over the age of patients with severe community-acquired pneumonia in 117 cases (excluding patients with malignant tumors of pneumonia), according to data recorded the patient clinical history information, vital signs, The total length of hospital stay, ICU stay the case, past history of the disease, and surgery; and records of early onset of clinical symptoms, laboratory tests after admission and imaging; retrospective analysis of clinical data, using descriptive research method The general case of the clinical data collected for analysis. Multivariate logistic regression using the method of analysis of elderly patients with basic information on SCAP comparison meaningful factors into circulation. Results The comprehensive treatment measures (including anti-infection, secondary respiratory therapy immunotherapy, supportive care, and sputum drainage, etc.), one of the 58 patients with good prognosis (better),59 patients with poor prognosis (death, including after treatment without Better to give up treatment after discharge by telephone follow-up of dead patients). logistic regression showed that among older people with severe community acquired pneumonia prognostic factors for the artificial airway, there is underlying disease, multiple organ failure, respiratory acidosis, hypoproteinemia, hyponatremia, age. Conclusion:should pay attention to the impact of risk factors on the prognosis of the dynamic observation of the targets for clinical prevention and treatment of reference, timely and correct treatment, to improve the patient's condition and reduce mortality and improve the treatment success rate.
Objective:our hospital nearly a decade older patients with severe community-acquired pneumonia clinical data, reviewed in our hospital of severe community-acquired pneumonia clinical features and prognostic factors of influence, in order to further improve the clinical Provide the reference treatment. Methods:our hospital in January 2000-2010 on January 60 over the age of patients with severe community-acquired pneumonia in 117 cases (excluding patients with malignant tumors of pneumonia), according to data recorded the patient clinical history information, vital signs, The total length of hospital stay, ICU stay the case, past history of the disease, and surgery; and records of early onset of clinical symptoms, laboratory tests after admission and imaging; retrospective analysis of clinical data, using descriptive research method The general case of the clinical data collected for analysis. Multivariate logistic regression using the method of analysis of elderly patients with basic information on SCAP comparison meaningful factors into circulation. Results The comprehensive treatment measures (including anti-infection, secondary respiratory therapy immunotherapy, supportive care, and sputum drainage, etc.), one of the 58 patients with good prognosis (better),59 patients with poor prognosis (death, including after treatment without Better to give up treatment after discharge by telephone follow-up of dead patients). logistic regression showed that among older people with severe community acquired pneumonia prognostic factors for the artificial airway, there is underlying disease, multiple organ failure, respiratory acidosis, hypoproteinemia, hyponatremia, age. Conclusion:should pay attention to the impact of risk factors on the prognosis of the dynamic observation of the targets for clinical prevention and treatment of reference, timely and correct treatment, to improve the patient's condition and reduce mortality and improve the treatment success rate.
引文
[1]Moran GJ,Talan DA,Abrahamian FM.Diagnosis and mall-agement of pneu monia in the emergency department[J].Infectious disease clinics of North A mericam,2008,22:53-72
[2]Marrie TJ.Severe Pneumonia.N Engl Med[J],2005,353:2626-2627
[3]杨静,刘洪斌.脓毒症免疫功能不全研究进展[J].中国中西医结合外科杂志,2009,15(4)：468-470
[4]李丰良,袁嘉丽,宋建新.医院下呼吸道感染患者T细胞亚群及红细胞膜免疫分子表达的研究[J].中国药物与临床,2006,6(6)：411-412
[5]姜琳,干月娇,李利.老年人重症肺炎156例临床分析[J].职业与健康,2005,21(9)：1400-1401
[6]Working Gmup of the South African Thoracic SOciety.Management of communitr acquired pneumonia in adults[J].S Afr Med,2007,97(12 Pt 2):1296-1306
[7]方怡,冉丕鑫.重症社区获得性肺炎炎性机制研究进展[J].国外医学呼吸系统分册,2005,25(1)23-29
[8]Janssens JP. Pneumonia in the elderly (geriatric) population[J].CurrOpin Pulm Med,2005,11 (3):226-230
[9]Viegi G,Pistelli R,Cazzola M. Epidemiological survey on incidence And treatment of community acquired pneumonia in Italy[J].Respir Med,2006,100 (1):46-55
[10]黄念秋,吴善.现代老年呼吸病学[M].北京：人民军医出版社,1998：537-541
[11]Dryden M,Hand K,Davey P.Antibiotics for community acquired pneumo nia [J].Antimicrob Chemother,2009,64(6):1123-1125
[12]孙铁英,刘兵,杨敏.社区获得性肺炎老年住院患者的临床分析[J].中国老年医学杂志,2005,24(2)：100-102
[13]Hoerauf A,Hammer S,M yhsok MR.Intraabdominal candida infection during acute necrotizingpancreatis has a highpreva lance and is associated with increased mortality[J].Crit Care Med,1998,26 (2):201
[14]陈恒屹,崔社怀.重症社区获得性肺炎病死率及预后分析[J].中华肺部疾病杂志,2010,3(5)：332-334
[15]第八届全国人民代表大会常务委员会.《中华人民共和国老年人权益保障法》第二条[M].北京：法律出版社,1998
[16]Yende S, Angus DC,Ali IS.Infl uence of comorbid conditions on long-term mortality after pneumonia in older people[J]. J Am GeriatrSoc,2007,55 (4):518-525
[17]Siebenlist U,Brown K,Claudio E.Control of lymphocyte development by nuclear factor_kappaB[J].Nat Rev Immunol,2005,5:435-445
[18]Mandell LA,Wunderink RG,Anzueto A.Infectious Diseases Society of Amer ican/American Thoracic Society consensus guidelines on the management o f community-acquired pneumoniain adults[J]. Clinical Infectious Diseases,2 007,(44):27-72
[19]American Thoracic Society. Guidelines for the managem ent of adults with community acquired pneumonia. Diagnosis, assessment of everityantimicrobial therapy and prevention[J]. Am JRespir CritCare med,2001,163(7):1730-1754.
[20]易慧,谢灿茂.重症肺炎临床及预后因素分析[J].中华医院感染学杂志,2008,18(1)：56-58
[21]陈庆,梁宗安,李凯.重症社区获得性肺炎的预后及激素应用临床探讨[J].华西医学,2008,23(5)：1042-1043
[22]刘慧,张天托,吴本权,等.老年社区获得性肺炎住院患者的临床资料分析[J].中华内科杂志,2007,46(10)：810-814
[23]Marrie T.community acquired pneumonia[J].New york Kluwer Academic/Plenum Publ,2001:387-413
[24]Venkatesan P,Gladman J,Macfarlane JT, et al.A hospital study of community acquired pneumonia in the elderly [J].Thorax,1990,45 (4):254-258
[25]Riquelme R,Torres A, el-Ebiary M, et al.Community-acquired pneumonia in the elderly.Clinical and nutrional aspects[J].Am J Respir Crit Care Med,1997,156 (6):1908-1914
[26]Janssens JP,Krause KH.Pneumonia in the very old[J].Lancet Infect Dis,2004 (2):112-124
[27]Gutierrez F,Masia M.I,mprovingout comes of elderly patients with community acquired pneumonia[J].DrugsAging,2008,25(7):58-61
[28]Fine MJ,Auble TE,Yealy DM, etal.A prediction rule to identify low risk patients with community-acquired pneumonia[J].N Engl J Med,1997,336 (4):243-250
[29]Lim WS,Eerden MMV,Laing R, et al.Defining community acquired pneumonia severity on presentation to hospital:an international derivation and validation study[J].Thorax,2003,58 (5):377-382
[30]Rello J,Rodriguez A,Torres A, et al.Implications of COPD in patients admitted to the intensive care unit by community-acquiredpneumonia[J].Eur Respir,2006,27 (6):1210-1216
[31]Cabre M.Pneumonia in the elderly[J]. Curr Opin Pulm Med,2009,15(3):223-229
[32]Gutirrez F, Masi M. Improving out comes of elderly patients with community acquired pneumonia[J]. Drugs Aging,2008,25(7):585-610
[33]Schaaf B,Kruse J,Rupp J,etal.Sepsis severity predicts outcome in community-acquired pneumococcal pneumonia[J].Eur Respir,2007,30 (3):517-524.
[34]Yachimski PS,Friedman LS.Gastrointestinal bleeding in the elderly[J].Nat Clin Pract Gastuoenterol Hepatol,2008,5(2):80-93
[35]Pifarre R,Falguera M,Vicente-de-Vera C, etal.Characteristics of community-a cquired pneumonia in patients with chronic obstructive pulmonary disease[J]. Respir Med,2007,101 (10):2139-2144
[36]Kouche K, Cavadore P, Portales P, etal.Continuous veno-venous hemofiltration im-proves hemodynamics in septic shockwith a-cute renal failure without modifying TNF-a and IL-6plasma concentrations [J]. Nephro,2002,15 (2):150
[37]郝建,张益群,彭晓露,等.重症肺部感染患者缺氧与肝功能损害的相关性研究[J].实用肝脏病杂志,2008,11(1)：24-25
[38]Siegel G, Shafer P,Winkler K, etal. Ginkgo biloba (EGb 761) in arterio 2 sclerosis p rophylaxis. WienMedWochenschr[J],2007,157:288-294
[39]游海波,王强,李旭宏,等.甘氨酸对内毒素性肝损害保护作用的实验研究[J].中华肝脏病杂志,2006,14(8)：574-577
[40]郭玉香,陈凌,吴清家.重症肺炎致急性肝损害16例临床分析[J].临床医学,2006,26(10)：57
[41]王士雯,钱小顺.老年多器官衰竭肺启动的研究进展[J].中华老年医学杂志,2005,24(4)：313～316
[42]王静,乔万海.全身炎症反应综合征和多器官功能不全综合征的基因调控和治疗进展[J].中国全科医学,2006,9(19)：1634
[43]张梅,陈思.重症肺炎并低钠血症34例临床分析[J].现代临床医学,2006,32(4)：254
[44]程玉梅,沈峰,王迪芬,等.危重症患者270例酸碱失衡与电解质紊乱分析[N].贵阳医学院学报,2008,33(5)：527-529
[45]任成山,程相岭,赵晓晏.肝性脑病酸碱平衡紊乱与预后关系的研究[J].中国急救医学,2000,20(9)：514-516
[46]张业,刘政,孔磊.重症肺炎与病原菌耐药[J].中华医院感染学杂志,2008,1(11)；1648-1650
[47]Espana PP, Capelastegu iA, Gorordo I, eta 1. Developm en t and validat ion of a clinical pred iction ru le for severe community acquired pneumon [J].Am Respire Crit Care Med,2006,174 (11):1249-1256
[48]CD Furman,M.S.P.H,AV Rayner,EP Tobin.Pneumonia in older Residents of Long-Term care Facilities[J].Am Fam Phusician,2004,70:1495-1500
[49]Vincent JL,DuboisMJ,NavicksRJ,etal.Hypoalbuminemia in acute illness; is there a rationale fou interbention?A meta analysis of cohort studies and controlled trials[J].Ann Surg,2003,237(3):319-334
[1]梁颖,习听,刘双.成人重症社区获得性肺炎的诊治进展[J].中国全科医学,1007-9572(2008)06A-1005-03.1-2.
[2]Sanehez-Nieto JM Torres A,Gareia-Cordoba F,etal. ImPaetofinvasive and noninvas ive.quantitativeeul-turesampingonouteomeofventilatorassoeiatedPneumonia[J].AmJR esPirCritCareMed,1998,57(4).
[3]Ewig S, deRouxA, BauerT, eta.l Valida-tion of predictiverules and indices of severity f or community acquired pneumonia [J].Thorax,2004,59 (5):421-427.
[4]中华医学会呼吸学分会.社区获得性肺炎诊断和治疗指南[J].中华结核和呼吸杂志,2006,29(10)：653-654.
[5]Vineet JI Bihari DJ SuterPM,etal.Theprevalenee of nosoeomialinfeetion inintensive eareunitsin Eu-rope,resultsofthe European prevaleneeofin feetionininten、siveeare (EPIC) srudy.JAMA,1995;274(8):639.
[6]Cassiere HA.Confusionandmal nutrition equalspneu-moniainolder Patients[J].Clinie alPulmonary Medcine,1998;5(2),131.
[7]马兰.呼吸机相关性肺炎的诊治[J].中国临床医生,2010,0,007：21,1008-1089.
[8]何艳,陈雪英,孙碧云.老年重症肺炎15例死亡原因分析[J].贵州医药.1000-744X(2010)03-0255-02：255-256.
[9]李森范爱琴.老年重症肺炎并血清电解质异常临床分析[J].中国临床医学Apr,2010,vol.29.No.(4)：50-51.
[10]徐良志,陈积党,陈先配.重症肺炎与血清电解质异常的关系[J].重庆医学,2007,36(12)：12-20.
[11]Hoerauf A,Hammer S,Myhsok MB, et a.l Intraabdominal candida infec-tion duing acute necrotizing pancreatis has a highpreva-lence andis asso-ciated with increased mortality[J].Cri tCareMed,1998,26(2):201.
[12]覃红艳,李萍.老年重症肺炎抗生素降阶梯治疗的疗效分析[J]. Chin J of Clinical Rational Drug Use,April2010,Vol·3 No·8:65-66.
[13]杨小青,黄英.儿童重症肺炎的高危因素认识及其对策[J].儿科药学杂志,2010,(2)：80-85
[14]Gessler P, Martin F, Suter D, Berger C.Acta Paediatrica[J],International Journal of Paediatrics 2010,99(7):1005-1010).
[15]Rudan I, Boschi Pinto C, Biloglav Z, et al. Epidemiology and etiology of childhood pneumonia[J]. Bull World Health Organ,2008,86(5):408-416.
[16]袁壮,马沛然,邓力等.50年来小儿肺炎诊治策略的变迁[J].中国实用儿科杂志,2006,21(12)：881-908.
[17]中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童社区获得性肺炎管理指南(试行)(上)[J].中华儿科杂志,2007,(45)：83-90.
[18]Hazir T, Fox LM. Ambulatory short course high dose oral amoxicillin for treatment of severe pneumonia in children:a randomised equivalency trial [J]. Lancet, 2008,371(9606).
[19]Cheong HF, Ger LP. Clinical application of the rapid pneumococcal urinary antigen test in the treatment of severe pneumonia in children [J]. J Microbiol Immunol Infect, 2008,41(1):41-47.
[20]刘纯义,张侃,陆必森.细菌性重症肺炎患儿的病原菌分析及治疗对策[J].小儿急救医学,2005,(2)：102-103
[21]Rojas MX, Granados C. Oral antibiotics versus parenteral antibiotics for severe pneumonia in children [J]. Cochrane Database Syst Rev,2006, (2):CD4979.
[22]郭虹晨.小儿重症肺炎合并多器官功能衰竭27例临床分析[J].现代医药卫生.2010,(9)：102-103.
[23]林贞.邱彬玮.丙种球蛋白治疗小儿重症肺炎68例临床观察[J].中国临床医生2010,(5)：93-95
[24]Basnet S, Adhikari RK. Hypoxemia in children with pneumonia and its clinical predictors [J]. Indian J Pediatr,2006,73(9):777-781.
[25]易慧；谢灿茂.重症肺炎临床及预后因素分析[J].中华医院感染学杂志,2008,(1)：80-85
[26]Goodnight WH, Scoper DE. Pneumonia in pregnancy [J]. Crit Care Care Med,2005, 33 (10Suppl):S390-397.
[27]Mak TK, Manqtani P, Leese J, et al. Influenza vaccination in preg-nancy:current evidence and selected national policies[J]. LancetInfect Dis,2008,8(1):44-52.
[28]Barros F.C., Bhutta Z.A., Batra M., Global report on preterm birth and stillbirth (3 of 7):evidence for effectiveness of interventions[J]. BMC pregnancy and childbirth 2010,10 Suppl 1 (S3):15-17.
[29]Mercieri M., Di Rosa R, Pantosti A. Critical pneumonia complicating early-stage pregnancy[J]. Anesthesia and Analgesia 2010,(110):852-854.
[30]Romanyuk V, Raichel L, Sergienko R, Sheiner E Pneumonia during pregnancy: radiological characteristics, predisposing factors and pregnancy outcomes[J].Matern Fetal Neonatal Med,2010 May.
[31]Shariatzadeh MR. Pneumonia during pregnancy [J]. Am J Med,2006,119 (10) 872-876.
[32]陆慰萱.爱滋病肺部合并症6例分析(J].中华结核和呼吸杂志,1999,22(8)：465
[33]Schnell D, Mayaux J, de Bazelaire C. Pneumonia during pregnancy [J].Respiratory Medicine,2010,104(7):1050-1056.
[34]Perello R, Miro O, Marcos MA. Predicting bacteremic pneumonia in HIV-1-infected patients [J]. Respiratory Medicine,2010,May:28(4):454.
[35]J Bras. Fungal infections in immunocompromised patients Pneumol[J]. Intensive Care Med,2010,Feb:36(1):142-7.
[36]Working Gmup of the SOuth African Thoraci Society.Management ofcommunitr acquired pneumonia in adults.S AfrMed J.2007,97(12 Pt 2):1296-1306.
[37]Chan K.Y.K., Xu M.-S., Ching J.C.Y. CD209 (DC-SIGN)-336A>G promoter polymorphism and severe acute respiratory syndrome in Hong Kong Chinese. [In Process] Human Immunology 2010,71:7 (702-707).
[38]Rey C, Los Arcos M. Procalciton in and C reactive protein as markers of systemic inflammatory response syndrome severity in critically ill children[J]. Intensive Care Med,2007,33(3):477-484.
[39]Confalonieri M, Trevisan R. Prolonged infusion of hydrocortisone in patients with severe community acquired pneumonia [J]. Recenti Prog Med,2006,97 (1):32-36.
[40]Salluh JI, Povoa P, Soares M. The role of corticosteroids in severe communit y acquired pneumonia:a systematic review [J]. Crit Care,2008,12(3):R76.
[41]Brooks WA, Yunus M. Zinc for severe pneumonia in very young children, do uble blind placebo controlled trial [J]. Lancet,2004,363(9422):1683-1688
[42]Bose A, Coles CL. Efficacy of zinc in the treatment of severe pneumonia in hospitalized children<2 y old [J]. Am J Clin Nutr,2006,83(5):1089-1896.
[2]Marrie TJ.Severe Pneumonia.N Engl Med[J],2005,353:2626-2627
[3]杨静,刘洪斌.脓毒症免疫功能不全研究进展[J].中国中西医结合外科杂志,2009,15(4)：468-470
[4]李丰良,袁嘉丽,宋建新.医院下呼吸道感染患者T细胞亚群及红细胞膜免疫分子表达的研究[J].中国药物与临床,2006,6(6)：411-412
[5]姜琳,干月娇,李利.老年人重症肺炎156例临床分析[J].职业与健康,2005,21(9)：1400-1401
[6]Working Gmup of the South African Thoracic SOciety.Management of communitr acquired pneumonia in adults[J].S Afr Med,2007,97(12 Pt 2):1296-1306
[7]方怡,冉丕鑫.重症社区获得性肺炎炎性机制研究进展[J].国外医学呼吸系统分册,2005,25(1)23-29
[8]Janssens JP. Pneumonia in the elderly (geriatric) population[J].CurrOpin Pulm Med,2005,11 (3):226-230
[9]Viegi G,Pistelli R,Cazzola M. Epidemiological survey on incidence And treatment of community acquired pneumonia in Italy[J].Respir Med,2006,100 (1):46-55
[10]黄念秋,吴善.现代老年呼吸病学[M].北京：人民军医出版社,1998：537-541
[11]Dryden M,Hand K,Davey P.Antibiotics for community acquired pneumo nia [J].Antimicrob Chemother,2009,64(6):1123-1125
[12]孙铁英,刘兵,杨敏.社区获得性肺炎老年住院患者的临床分析[J].中国老年医学杂志,2005,24(2)：100-102
[13]Hoerauf A,Hammer S,M yhsok MR.Intraabdominal candida infection during acute necrotizingpancreatis has a highpreva lance and is associated with increased mortality[J].Crit Care Med,1998,26 (2):201
[14]陈恒屹,崔社怀.重症社区获得性肺炎病死率及预后分析[J].中华肺部疾病杂志,2010,3(5)：332-334
[15]第八届全国人民代表大会常务委员会.《中华人民共和国老年人权益保障法》第二条[M].北京：法律出版社,1998
[16]Yende S, Angus DC,Ali IS.Infl uence of comorbid conditions on long-term mortality after pneumonia in older people[J]. J Am GeriatrSoc,2007,55 (4):518-525
[17]Siebenlist U,Brown K,Claudio E.Control of lymphocyte development by nuclear factor_kappaB[J].Nat Rev Immunol,2005,5:435-445
[18]Mandell LA,Wunderink RG,Anzueto A.Infectious Diseases Society of Amer ican/American Thoracic Society consensus guidelines on the management o f community-acquired pneumoniain adults[J]. Clinical Infectious Diseases,2 007,(44):27-72
[19]American Thoracic Society. Guidelines for the managem ent of adults with community acquired pneumonia. Diagnosis, assessment of everityantimicrobial therapy and prevention[J]. Am JRespir CritCare med,2001,163(7):1730-1754.
[20]易慧,谢灿茂.重症肺炎临床及预后因素分析[J].中华医院感染学杂志,2008,18(1)：56-58
[21]陈庆,梁宗安,李凯.重症社区获得性肺炎的预后及激素应用临床探讨[J].华西医学,2008,23(5)：1042-1043
[22]刘慧,张天托,吴本权,等.老年社区获得性肺炎住院患者的临床资料分析[J].中华内科杂志,2007,46(10)：810-814
[23]Marrie T.community acquired pneumonia[J].New york Kluwer Academic/Plenum Publ,2001:387-413
[24]Venkatesan P,Gladman J,Macfarlane JT, et al.A hospital study of community acquired pneumonia in the elderly [J].Thorax,1990,45 (4):254-258
[25]Riquelme R,Torres A, el-Ebiary M, et al.Community-acquired pneumonia in the elderly.Clinical and nutrional aspects[J].Am J Respir Crit Care Med,1997,156 (6):1908-1914
[26]Janssens JP,Krause KH.Pneumonia in the very old[J].Lancet Infect Dis,2004 (2):112-124
[27]Gutierrez F,Masia M.I,mprovingout comes of elderly patients with community acquired pneumonia[J].DrugsAging,2008,25(7):58-61
[28]Fine MJ,Auble TE,Yealy DM, etal.A prediction rule to identify low risk patients with community-acquired pneumonia[J].N Engl J Med,1997,336 (4):243-250
[29]Lim WS,Eerden MMV,Laing R, et al.Defining community acquired pneumonia severity on presentation to hospital:an international derivation and validation study[J].Thorax,2003,58 (5):377-382
[30]Rello J,Rodriguez A,Torres A, et al.Implications of COPD in patients admitted to the intensive care unit by community-acquiredpneumonia[J].Eur Respir,2006,27 (6):1210-1216
[31]Cabre M.Pneumonia in the elderly[J]. Curr Opin Pulm Med,2009,15(3):223-229
[32]Gutirrez F, Masi M. Improving out comes of elderly patients with community acquired pneumonia[J]. Drugs Aging,2008,25(7):585-610
[33]Schaaf B,Kruse J,Rupp J,etal.Sepsis severity predicts outcome in community-acquired pneumococcal pneumonia[J].Eur Respir,2007,30 (3):517-524.
[34]Yachimski PS,Friedman LS.Gastrointestinal bleeding in the elderly[J].Nat Clin Pract Gastuoenterol Hepatol,2008,5(2):80-93
[35]Pifarre R,Falguera M,Vicente-de-Vera C, etal.Characteristics of community-a cquired pneumonia in patients with chronic obstructive pulmonary disease[J]. Respir Med,2007,101 (10):2139-2144
[36]Kouche K, Cavadore P, Portales P, etal.Continuous veno-venous hemofiltration im-proves hemodynamics in septic shockwith a-cute renal failure without modifying TNF-a and IL-6plasma concentrations [J]. Nephro,2002,15 (2):150
[37]郝建,张益群,彭晓露,等.重症肺部感染患者缺氧与肝功能损害的相关性研究[J].实用肝脏病杂志,2008,11(1)：24-25
[38]Siegel G, Shafer P,Winkler K, etal. Ginkgo biloba (EGb 761) in arterio 2 sclerosis p rophylaxis. WienMedWochenschr[J],2007,157:288-294
[39]游海波,王强,李旭宏,等.甘氨酸对内毒素性肝损害保护作用的实验研究[J].中华肝脏病杂志,2006,14(8)：574-577
[40]郭玉香,陈凌,吴清家.重症肺炎致急性肝损害16例临床分析[J].临床医学,2006,26(10)：57
[41]王士雯,钱小顺.老年多器官衰竭肺启动的研究进展[J].中华老年医学杂志,2005,24(4)：313～316
[42]王静,乔万海.全身炎症反应综合征和多器官功能不全综合征的基因调控和治疗进展[J].中国全科医学,2006,9(19)：1634
[43]张梅,陈思.重症肺炎并低钠血症34例临床分析[J].现代临床医学,2006,32(4)：254
[44]程玉梅,沈峰,王迪芬,等.危重症患者270例酸碱失衡与电解质紊乱分析[N].贵阳医学院学报,2008,33(5)：527-529
[45]任成山,程相岭,赵晓晏.肝性脑病酸碱平衡紊乱与预后关系的研究[J].中国急救医学,2000,20(9)：514-516
[46]张业,刘政,孔磊.重症肺炎与病原菌耐药[J].中华医院感染学杂志,2008,1(11)；1648-1650
[47]Espana PP, Capelastegu iA, Gorordo I, eta 1. Developm en t and validat ion of a clinical pred iction ru le for severe community acquired pneumon [J].Am Respire Crit Care Med,2006,174 (11):1249-1256
[48]CD Furman,M.S.P.H,AV Rayner,EP Tobin.Pneumonia in older Residents of Long-Term care Facilities[J].Am Fam Phusician,2004,70:1495-1500
[49]Vincent JL,DuboisMJ,NavicksRJ,etal.Hypoalbuminemia in acute illness; is there a rationale fou interbention?A meta analysis of cohort studies and controlled trials[J].Ann Surg,2003,237(3):319-334
[1]梁颖,习听,刘双.成人重症社区获得性肺炎的诊治进展[J].中国全科医学,1007-9572(2008)06A-1005-03.1-2.
[2]Sanehez-Nieto JM Torres A,Gareia-Cordoba F,etal. ImPaetofinvasive and noninvas ive.quantitativeeul-turesampingonouteomeofventilatorassoeiatedPneumonia[J].AmJR esPirCritCareMed,1998,57(4).
[3]Ewig S, deRouxA, BauerT, eta.l Valida-tion of predictiverules and indices of severity f or community acquired pneumonia [J].Thorax,2004,59 (5):421-427.
[4]中华医学会呼吸学分会.社区获得性肺炎诊断和治疗指南[J].中华结核和呼吸杂志,2006,29(10)：653-654.
[5]Vineet JI Bihari DJ SuterPM,etal.Theprevalenee of nosoeomialinfeetion inintensive eareunitsin Eu-rope,resultsofthe European prevaleneeofin feetionininten、siveeare (EPIC) srudy.JAMA,1995;274(8):639.
[6]Cassiere HA.Confusionandmal nutrition equalspneu-moniainolder Patients[J].Clinie alPulmonary Medcine,1998;5(2),131.
[7]马兰.呼吸机相关性肺炎的诊治[J].中国临床医生,2010,0,007：21,1008-1089.
[8]何艳,陈雪英,孙碧云.老年重症肺炎15例死亡原因分析[J].贵州医药.1000-744X(2010)03-0255-02：255-256.
[9]李森范爱琴.老年重症肺炎并血清电解质异常临床分析[J].中国临床医学Apr,2010,vol.29.No.(4)：50-51.
[10]徐良志,陈积党,陈先配.重症肺炎与血清电解质异常的关系[J].重庆医学,2007,36(12)：12-20.
[11]Hoerauf A,Hammer S,Myhsok MB, et a.l Intraabdominal candida infec-tion duing acute necrotizing pancreatis has a highpreva-lence andis asso-ciated with increased mortality[J].Cri tCareMed,1998,26(2):201.
[12]覃红艳,李萍.老年重症肺炎抗生素降阶梯治疗的疗效分析[J]. Chin J of Clinical Rational Drug Use,April2010,Vol·3 No·8:65-66.
[13]杨小青,黄英.儿童重症肺炎的高危因素认识及其对策[J].儿科药学杂志,2010,(2)：80-85
[14]Gessler P, Martin F, Suter D, Berger C.Acta Paediatrica[J],International Journal of Paediatrics 2010,99(7):1005-1010).
[15]Rudan I, Boschi Pinto C, Biloglav Z, et al. Epidemiology and etiology of childhood pneumonia[J]. Bull World Health Organ,2008,86(5):408-416.
[16]袁壮,马沛然,邓力等.50年来小儿肺炎诊治策略的变迁[J].中国实用儿科杂志,2006,21(12)：881-908.
[17]中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童社区获得性肺炎管理指南(试行)(上)[J].中华儿科杂志,2007,(45)：83-90.
[18]Hazir T, Fox LM. Ambulatory short course high dose oral amoxicillin for treatment of severe pneumonia in children:a randomised equivalency trial [J]. Lancet, 2008,371(9606).
[19]Cheong HF, Ger LP. Clinical application of the rapid pneumococcal urinary antigen test in the treatment of severe pneumonia in children [J]. J Microbiol Immunol Infect, 2008,41(1):41-47.
[20]刘纯义,张侃,陆必森.细菌性重症肺炎患儿的病原菌分析及治疗对策[J].小儿急救医学,2005,(2)：102-103
[21]Rojas MX, Granados C. Oral antibiotics versus parenteral antibiotics for severe pneumonia in children [J]. Cochrane Database Syst Rev,2006, (2):CD4979.
[22]郭虹晨.小儿重症肺炎合并多器官功能衰竭27例临床分析[J].现代医药卫生.2010,(9)：102-103.
[23]林贞.邱彬玮.丙种球蛋白治疗小儿重症肺炎68例临床观察[J].中国临床医生2010,(5)：93-95
[24]Basnet S, Adhikari RK. Hypoxemia in children with pneumonia and its clinical predictors [J]. Indian J Pediatr,2006,73(9):777-781.
[25]易慧；谢灿茂.重症肺炎临床及预后因素分析[J].中华医院感染学杂志,2008,(1)：80-85
[26]Goodnight WH, Scoper DE. Pneumonia in pregnancy [J]. Crit Care Care Med,2005, 33 (10Suppl):S390-397.
[27]Mak TK, Manqtani P, Leese J, et al. Influenza vaccination in preg-nancy:current evidence and selected national policies[J]. LancetInfect Dis,2008,8(1):44-52.
[28]Barros F.C., Bhutta Z.A., Batra M., Global report on preterm birth and stillbirth (3 of 7):evidence for effectiveness of interventions[J]. BMC pregnancy and childbirth 2010,10 Suppl 1 (S3):15-17.
[29]Mercieri M., Di Rosa R, Pantosti A. Critical pneumonia complicating early-stage pregnancy[J]. Anesthesia and Analgesia 2010,(110):852-854.
[30]Romanyuk V, Raichel L, Sergienko R, Sheiner E Pneumonia during pregnancy: radiological characteristics, predisposing factors and pregnancy outcomes[J].Matern Fetal Neonatal Med,2010 May.
[31]Shariatzadeh MR. Pneumonia during pregnancy [J]. Am J Med,2006,119 (10) 872-876.
[32]陆慰萱.爱滋病肺部合并症6例分析(J].中华结核和呼吸杂志,1999,22(8)：465
[33]Schnell D, Mayaux J, de Bazelaire C. Pneumonia during pregnancy [J].Respiratory Medicine,2010,104(7):1050-1056.
[34]Perello R, Miro O, Marcos MA. Predicting bacteremic pneumonia in HIV-1-infected patients [J]. Respiratory Medicine,2010,May:28(4):454.
[35]J Bras. Fungal infections in immunocompromised patients Pneumol[J]. Intensive Care Med,2010,Feb:36(1):142-7.
[36]Working Gmup of the SOuth African Thoraci Society.Management ofcommunitr acquired pneumonia in adults.S AfrMed J.2007,97(12 Pt 2):1296-1306.
[37]Chan K.Y.K., Xu M.-S., Ching J.C.Y. CD209 (DC-SIGN)-336A>G promoter polymorphism and severe acute respiratory syndrome in Hong Kong Chinese. [In Process] Human Immunology 2010,71:7 (702-707).
[38]Rey C, Los Arcos M. Procalciton in and C reactive protein as markers of systemic inflammatory response syndrome severity in critically ill children[J]. Intensive Care Med,2007,33(3):477-484.
[39]Confalonieri M, Trevisan R. Prolonged infusion of hydrocortisone in patients with severe community acquired pneumonia [J]. Recenti Prog Med,2006,97 (1):32-36.
[40]Salluh JI, Povoa P, Soares M. The role of corticosteroids in severe communit y acquired pneumonia:a systematic review [J]. Crit Care,2008,12(3):R76.
[41]Brooks WA, Yunus M. Zinc for severe pneumonia in very young children, do uble blind placebo controlled trial [J]. Lancet,2004,363(9422):1683-1688
[42]Bose A, Coles CL. Efficacy of zinc in the treatment of severe pneumonia in hospitalized children<2 y old [J]. Am J Clin Nutr,2006,83(5):1089-1896.