本文選題：腦出血 + 重癥肺炎　； 參考：《中華醫(yī)院感染學(xué)雜志》2017年22期

【摘要】：目的分析老年腦出血患者醫(yī)院獲得性重癥肺炎的床旁超聲影像特點(diǎn),分析其對(duì)預(yù)后的影響。方法選取2015年1月-2016年12月醫(yī)院收治的腦出血并發(fā)肺炎的患者178例,根據(jù)重癥肺炎診斷標(biāo)準(zhǔn),其中94例患者為重癥肺炎,84例患者為普通肺炎,對(duì)所有患者進(jìn)行床旁超聲檢查,觀察影像學(xué)特點(diǎn),綜合分析患者的超聲評(píng)分結(jié)果及臨床資料,評(píng)估床旁超聲影像結(jié)果對(duì)臨床預(yù)后的影響。結(jié)果重癥肺炎患者發(fā)生肺實(shí)變61例,實(shí)變率64.9%,普通肺炎患者肺實(shí)變7例,實(shí)變率8.3%,兩組差異有統(tǒng)計(jì)學(xué)意義(P0.05);重癥肺炎患者胸膜下病變數(shù)為(4.86±2.63)個(gè),高于普通肺炎患者的(2.09±1.14)個(gè),差異有統(tǒng)計(jì)學(xué)意義(P0.05);重癥肺炎患者發(fā)生胸膜改變的肋間個(gè)數(shù)為(8.22±2.31)個(gè),高于普通肺炎患者的(2.54±1.08)個(gè),差異有統(tǒng)計(jì)學(xué)意義(P0.05);重癥肺炎肺超聲評(píng)分為(21.28±5.49)分,低于普通肺炎患者的(30.83±5.83)分,差異有統(tǒng)計(jì)學(xué)意義(P0.05);死亡患者肺實(shí)變率100%,胸膜下病變數(shù)(5.34±2.35)個(gè),胸膜改變肋間個(gè)數(shù)(9.26±2.51)個(gè),肺超聲評(píng)分為(14.36±2.46)分。結(jié)論老年腦出血患者醫(yī)院獲得性重癥肺炎的床旁超聲影像特點(diǎn)為肺實(shí)變、胸膜下病變數(shù)多、胸膜改變肋間數(shù)多、肺超聲評(píng)分低,當(dāng)床旁超聲結(jié)果為肺實(shí)變、胸膜下病變數(shù)超過(guò)5個(gè)、胸膜改變肋間個(gè)數(shù)超過(guò)9個(gè)、肺超聲評(píng)分低于15分時(shí),往往提示預(yù)后不佳,需要臨床醫(yī)師高度關(guān)注。
[Abstract]:Objective to analyze the characteristics of bedside ultrasonography in elderly patients with nosocomial severe pneumonia and its influence on prognosis.Methods 178 cases of intracerebral hemorrhage complicated with pneumonia were selected from January 2015 to December 2016. According to the diagnostic criteria of severe pneumonia, 94 cases were diagnosed as severe pneumonia and 84 cases were common pneumonia. All the patients were examined by bedside ultrasound.The imaging features were observed and the clinical data were analyzed comprehensively. The influence of bedside ultrasound findings on the clinical prognosis was evaluated.Results there were 61 patients with severe pneumonia with a consolidation rate of 64.9 and 7 patients with common pneumonia with a consolidation rate of 8.3.The difference between the two groups was statistically significant (P 0.05), and the number of subpleural lesions in severe pneumonia patients was 4.86 鹵2.63, which was higher than that in common pneumonia patients (2.09 鹵1.14).The number of intercostal changes in patients with severe pneumonia was 8.22 鹵2.31, which was higher than that in patients with common pneumonia (2.54 鹵1.08), the difference was statistically significant (P0.05), and the ultrasonic score of severe pneumonia was 21.28 鹵5.49, which was lower than that of patients with common pneumonia (30.83 鹵5.83).The number of subpleural lesions was 5.34 鹵2.35, the number of intercostal changes of pleura was 9.26 鹵2.51, and the score of pulmonary ultrasound was 14.36 鹵2.46. The difference was statistically significant (P < 0.05), the rate of pulmonary consolidation was 100 and the number of subpleural lesions was 5.34 鹵2.35, and the number of intercostal changes of pleura was 9.26 鹵2.51.Conclusion the characteristics of bedside ultrasonography in elderly patients with nosocomial severe pneumonia are pulmonary consolidation, more subpleural lesions, more intercostal pleural changes, and lower pulmonary ultrasound scores.When the number of subpleural lesions was more than 5, the number of intercostal pleural changes was more than 9, and the ultrasonic score of lung was less than 15, the prognosis was not good, and the clinicians should pay close attention to it.
【作者單位】： 海南醫(yī)學(xué)院第二附屬醫(yī)院超聲醫(yī)學(xué)科;
【基金】：海南省衛(wèi)生廳科研基金資助項(xiàng)目(瓊衛(wèi)2012LX-12)
【分類號(hào)】：R445.1;R563.1;R743.34

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