有食管癌病史肺炎疗效差危险因素分析.docVIP

有食管癌病史肺炎疗效差危险因素分析 　　[摘要] 目的 ?u价在呼吸内科住院的有食管癌病史的肺炎患者疗效差的危险因素。方法 对2008年3月―2014年2月共6年来在呼吸内科住院的94例食管癌合并肺炎患者的临床资料进行了回顾性分析。疗效差定义为死亡，或者症状、体温、血常规、血气分析、肺部影像学中任一项差的结局。采用单因素和多因素分析各种危险因素。结果 有食管癌病史的肺炎的主要症状为咳嗽、咳痰、呼吸困难。常见的体征为呼吸音降低和湿??音。痰病原菌多样。影像学特征包括肺炎的多肺叶浸润、胸腔胃、胸腔积液、气管支气管受压、肺气肿、肺间质改变、支气管扩张、心包积液、可疑肺转移瘤等。差疗效组54例（占57.4%），好疗效组40例（占42.6%）。2组的基线人口学特征、食管癌治疗史、肺炎类型差异无统计学意义。多因素分析发现，呼吸困难（P=0.022， OR=3.791， 95%CI：1.215～11.826）是疗效差的独立危险因素，咯血（P=0.007，OR=0.143， 95%CI：0.035～0.593）是疗效好的独立相关因素。结论 早期识别疗效差的危险因素可能有助于改进治疗策略，提高有食管癌病史的肺炎患者的存活率 [关键词] 食管癌；肺炎；疗效差；危险因素 [中图分类号] R4 [文献标识码] A [文章编号] 1674-0742（2016）12（b）-0017-06 Analysis of the Risk Factors of Pneumonia Patients with a History of Esophageal Cancer WANG Zhang-hui Department of Respiratory Medicine，the First Affiliated Hospital of Xiamen University，Xiamen，Fujian Province， 361003 China [Abstract] Objective To evaluate risk factors for poor discharge outcome among pneumonia patients with histories of esophageal cancer admitted to respiratory department. Methods We retrospectively analyzed 94 pneumonia patients with histories of esophageal cancer admitted to respiratory department in from March 2008 to Febmary 2014. A poor outcome at discharge was defined as death， or any poor outcome of symptoms， temperature， complete blood count， arterial blood gas analysis， or pulmonary imaging. The risk factors were examined by univariate and multivariate logistic regression. Results Most pneumonia patients with histories of esophageal cancer complained of cough， expectoration and dyspnea. Common signs were decreased breath sounds and crackles. Varied kinds of bacteria was detected in sputum. The imaging characteristics included pneumonia of multilobar infiltrates， thoracostomach， pleural effusion， trachea or bronchus compression， emphysema， interstitial abnormalities， bronchiectasis， pericardial effusion， suspect pulmonary metastatic tumor， et al. There were 54 patients （57.4%） in poor outcome group and 40 patients （42.6%） in good outcome group，