The Clinical Analysis Of54Patients Caused By Severe Community Acquired Pneumonia

Objective: Severe community-acquired pneumonia (SCAP) is one of commonclinical critically disease in respiratory department.It is also a disease of difficulttreatment and poor prognosis,which threats to human health seriously.The main purposeof this study was to investigate the clinical feature, the etiologic characteristics, relateddrug sensitive test, the diagnosis and the treatment.The research helped us to strengthenthe disease and raise the level of diagnosis and treatment concerning SCAP.Methods: A restrospective analysis was used in this study. The54medicalrecords from January2006to September2011in the First Affiliated Hospital of DalianMedical University were fit with the diagnosis standard of SCAP.It analysed of thepatient’s age, basic disease situation, the clinical feature, radiological characteristics,laboratory inspection, the diagnosis and the treatment method.Results:1.General material:54patients included34male cases accounting for63.0%and20female cases accounting for37.0%. The age ranged from27years old to92yearsold.The average age was67±17years old.The median age was72years old. Therewere34patients of65years old, accounting for63.0%.2.The situation of foundation disease:26cases have basic diseases of54patients.2cases of chronic obstructive pulmonary disease(COPD),6cases ofdiabetes,1case of tumor,1case fracture surgery,10cases of cerebrovascular accident,1case of long-term hemodialysis,1case of Parkinson,1case of low intelligence,2casesof urinary tract infections,8cases of cardiovascular disease,28cases of healthy.3.Clinical performance: fever (>39℃)35patients accounted for64.8%,breathing frequency quartile30times/min24cases44.4%, blood pressure <90/60mmHg in7cases13.0%, cough, sputum43cases79.6%, lung auscultation smell wetdetect rales51cases94.4%, disorder of consciousness13cases accounted for24.1%. 4.Imaging feature: the X-ray or chest CT manifestations of the multiple forpatchy, boundary fuzzy invasion of the shadow, scope of two or more leaf47caseswere87.0%, atelectasis8cases of14.8%, interstitial lung change8cases of14.86%,above a performance with unilateral or bilateral pleural effusion33cases accounted for61.1%.5.Laboratory examination: blood oxygen partial pressure (PaO2)<60mmHg35cases64.8%, oxygen and index (PaO2/FiO2)≤25041cases75.9%, pH <7.3014cases of25.9%, urine output <20ml/h in12cases accounted for22.2%, The d-dimerrise, abnormal blood picture of37cases accounted for68.5%，white blood cells, blood(WBC)<4.0x109/L6cases of11.1%, blood WBC>10x109/L40patients with74.1%, blood WBC>20x109/L17cases31.5%, neutral grain of proportion rise88.9%48cases, platelets (PLT)<100x109/L18patients with33.3%, hemoglobin(HB)<100g/L14cases44.4%, C-c-reactive protein (CRP) increased16.7%in9cases,blood sedimentation (ESR) added fast17cases31.5%, electrolyte imbalance of38cases of70.4%, hyponatremia10cases accounted for18.5%, hypokalemia11caseswere20.4%, plasma albumin (ALB)<27g/L20cases of37.0%, blood urea nitrogen(BUN)>7.1mmol/L (20mg/dl)27cases of50%, more than twice the normaltransaminases associated8cases of14.8%, the blood culture positive8cases of13.8%,sputum culture positive39cases by72.2%.6.The situation of complications: respiratory failure35patients, septic shock in7cases, renal failure in12cases, heart failure in4,20cases of liver damage, acuterespiratory distress syndrome (ARDS)4cases, upper gastrointestinal bleeding in2cases,8cases of blood bacteremia.7.Treatment and prognosis:54cases were all given initial empiricalantimicrobial agents treatment, the combination of two or more kinds of antibiotics,thenbased on the etiology results choose sensitive antibiotics. At the same time they weregiven oxygen cure, nutrition support, early vein using small-dose hormones, maintainwater electrolyte and acid-base, deal with complication, including37routine usetracheal intubation mechanical ventilation.54cases in patients with23cases cure SCAP,death28patients, automatic discharge in3, case fatality ratio was51.9%.Conclusion: SCAP is the leading higher infectious diseases. This morality of thisstudy was51.9%.The proportion of most common pathogens of SCAP streptococcuspneumoniae was gradually declined, and the proportion of gram-negative coli,staphylococcus aureus, atypical pathogens and antibiotic resistant bacteria were increasing. The initial antibiotics combination was the prognosis of the protective factorin SCAP. Drop ladder therapy was the effective anti-infection treatment method.Medium and small doses of hormone, early mechanical entilation the prognosis forSCAP plays an important role. The d-dimer may become the important influence SCAPprognosis monitoring index.