Prognostic Factors Predicting Mortality in Lung Abscess, 154 Cases Analysis

肺膿瘍致死相關因子分析，154例探討

胥愛璽(Ai-Hsi Hsu) ； 李仁智(Jen-Jyh Lee) ； 楊治國(Gee-Gwo Yang)

《慈濟醫學雜誌》 17卷1期 (2005/02) Pp. 11-16

https://doi.org/10.6440/TZUCMJ.200502.0011

摘要

目的：肺膿瘍在臨床上仍十分常見，但即使近年來抗生素發展迅速，其死亡率仍舊偏高。因此本研究收集分析病人的年齡、性別、疾病抵禦能力及致病菌種等因素以期分析出何種因素與不良預後相關，並探討可否藉改變此因素以降低肺膿瘍之死亡率。材料與方法：於1989年至2003年154位於慈濟醫院花蓮院區因肺膿瘍住院病人，依其所屬相關疾病之不同分為二組：第一組為簡單肺膿瘍組，共62人次；第二組為複雜肺膿瘍組，共92人次。在統計方法上以倒敘方式搜集病人的相關病歷及放射學之相關資料。結果：值得注意的是在第二組複雜肺膿瘍組的病人中較少因厭氧菌而致病。而在第二組複雜肺膿瘍組中可發現只使用抗生素治療的病人呈現較高之死亡率。結論：只使用抗生素治療肺膿瘍在臨床上仍嫌不足，尤其當面對合併有其他復雜疾病的時候。本分析顯示當臨床上面對合併有其他復雜疾病時，早期利用診斷性胸腔穿刺或胸管引流以即早确立可能致病菌種，可降低肺膿瘍組病人之死亡率。

關鍵字

肺膿瘍 ； 死亡率 ； 預後

並列摘要

Objective: Lung abscess remains a very common disease clinically and its mortality is still significant despite of the development of newer antibiotics. Therefore, pertinent individual conditions, including age, gender, host defense, causative pathogens and treatment choices were analyzed for the purpose of identifying the possible factors predicting a poor outcome and then a better understanding might be achieved when dealing with this kind of disease. Materials and Methods: Between 1989 and early 2003, 154 patients (123 male vs 31 female) of lung abscess hospitalized at the Hualien branch of Tzu Chi hospital, were enrolled. Two groups were divided according to their underlying medical condition and 62 cases with simple co-existing diseases were labled as group 1; 92 cases with complicated co-existing diseases were labled as group 2. The medical records and roentgenographic files were reviewed retrospectively, and a statistical analysis was attempted. Results: In this study, age and host defense were unchangeable variants associated with a higher mortality rate; whereas an aggressive treatment modality choice, as direct aspiration from lung abscess or even tube drainage might decrease the mortality rate. It is noteworthy that fewer anaerobic organisms were isolated in the patients with sophisticated co-existing illness than those with simple co-existing medical conditions in this study. However, this study is a retrospective one, and it might exist many intrinsic limitation. Conclusion: Medical treatment with antibiotics alone, even with the advance of antibiotics during these recent years, might still be inadequate as the treatment of lung abscess. By a better understanding of the related background of this illness, a lower mortality rate might be expected for the foreseeable future.

並列關鍵字

lung abscess ； mortality rate ； predicting outcome