非hiv感染免疫抑制患者重症肺炎的临床特点及预后相关危险因素分析

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1、授予单位代码10089学号或申请号20153117中国图书分类号R563.1HebeiMedicalUniversity硕士学位论文专业学位非HIV感染免疫抑制患者重症肺炎的临床特点及预后相关危险因素分析研究生：顾莹导师：潘文森教授专业：内科学二级学院：河北医科大学第二医院2018年3月目录中文摘要················································································1英文摘要·································

2、···············································2英文缩写················································································4研究论文非HIV感染免疫抑制患者重症肺炎的临床特点及预后相关危险因素分析前言················································································6材料与方法···········

3、····························································7结果················································································8附图··············································································12附表········································

4、······································15讨论··············································································20结论··············································································27参考文献····························································

5、············27综述非HIV感染免疫抑制患者的肺炎········································32致谢·····················································································47个人简历··············································································48中文摘要非HIV感染免疫抑制患者重症肺炎的临

6、床特点及预后相关危险因素分析摘要目的：分析非HIV感染免疫抑制患者重症肺炎的临床特点及预后相关危险因素，为临床诊治提供参考。方法：选取收治河北医大二院呼吸二科重症监护病房中101例非HIV感染免疫抑制并发重症肺炎患者。根据患者入院后28d病情转归情况分为存活组和死亡组。对比分析两组患者入院一般情况及临床资料，并进行危险因素分析。结果：1两组患者性别、年龄、体重指数、住院时间、临床症状、72小时内液体正平衡人数、肺泡灌洗液中细胞学分类、基础疾病及激素和（或）免疫抑制剂治疗情况均无明显差异（P>0.05）。2影像学表现以双肺浸润为主，

7、累及间质性质的病变较多，死亡组气胸及纵隔气肿患者死亡率较高（P<0.05）。3感染病原体菌谱广，多重耐药菌及机会性感染几率高，死亡组多重耐药细菌感染患者多于存活组（P<0.05）。4患者病情重，其中死亡组APACHEII评分、hsCRP、NEUT%较高（P<0.05），LY、CD3+和CD4+细胞绝对计数及百分比较低（P<0.05），最终需要行有创机械通气患者比例较高（P<0.05）。结论：1死亡组APACHEII评分、hsCRP、NEUT%较高，LY、CD3+和CD4+细胞绝对计数及百分比较低，多重耐药细菌感染及发生呼吸机所致肺

8、损伤人数较多，需行有创机械通气率较高。2Logistic回归分析显示需行有创机械通气、发生呼吸机所致肺损伤是影响非HIV感染免疫抑制患者重症肺炎预后的独立危险因素。关键词:重症肺炎,非HIV感染免疫抑制,危险因素,重症监护病房,有创机械通气,呼吸机