重症肺炎患者支气管肺泡灌洗次数的影响因素分析

Risk factors for bronchoalveolar lavage times in patients with severe pneumonia

摘要:

目的 分析影响重症肺炎（SP）患者支气管肺泡灌洗（BAL）次数的因素，并构建回归方程，分析其预测价值。方法 回顾性分析2023年1月－2025年3月该院收治的行BAL治疗，且治疗后病情、血氧指标和炎症指标好转的116例SP患者的临床资料，根据患者BAL治疗次数，将其分为单次组（62例）和非单次组（54例）。采用单因素和多因素Logistic回归模型，分析影响SP患者BAL次数的危险因素，并构建回归方程，分析其预测价值。结果 单次组塑型痰栓率、胸腔积液率和黏膜糜烂率低于非单次组，发热时间短于非单次组，乳酸脱氢酶水平低于非单次组，氧合指数和血清白蛋白水平高于非单次组，差异均有统计学意义（P < 0.05）。多因素Logistic回归模型分析结果显示：塑型痰栓（OR＾ = 1.618，95%CI：1.074～2.437）、胸腔积液（OR＾ = 1.669，95%CI：1.074～2.593）、黏膜糜烂（OR＾ = 1.655，95%CI：1.112～2.464）、发热时间长（OR＾ = 1.578，95%CI：1.005～2.476）、血清白蛋白水平低（OR＾ = 1.605，95%CI：1.028～2.504）和血清乳酸脱氢酶水平高（OR＾ = 1.554，95%CI：1.073～2.251）为导致SP患者BAL次数增加的危险因素（P < 0.05）。回归方程：Logit（P）= -8.463+塑型痰栓×0.481 + 胸腔积液×0.512 + 黏膜糜烂×0.504 + 发热时间×0.456 + 血清白蛋白水平×0.473 + 血清乳酸脱氢酶水平×0.441（P < 0.05）。当Logit（P）> 0.89时，曲线下面积（AUC）为0.903，敏感度为88.71%（95%CI：83.82%~95.04%），特异度为83.33%（95%CI：73.20%～90.88%）。结论 导致SP患者BAL次数增加的危险因素包括：塑型痰栓、胸腔积液、黏膜糜烂、发热时间长、血清白蛋白水平低和血清乳酸脱氢酶水平高，据此构建的回归方程，具有较好的预测价值，但其外推性尚需多中心、大样本的研究验证。

Abstract:

Objective To analyze the influencing factors of the time of bronchoalveolar lavage (BAL) in patients with severe pneumonia (SP).Methods The clinical data of 116 patients with SP who were treated with BAL from January 2023 to March 2025 and whose condition, blood oxygen index and inflammatory index improved after treatment were retrospectively collected. According to the times of BAL, the patients were divided into the single group (62 cases) and the non-single group (54 cases). Univariate and multivariate logistic regression analysis were used to analyze the influencing factors affecting the times of BAL in patients with SP, and the regression equation was constructed to analyze its predictive value.Results The rates of plastic bronchitis, pleural effusion, mucosal erosion, duration of fever and lactate dehydrogenase level in the single group were lower than those in the non-single group (P < 0.05), and the oxygenation index and serum albumin level were higher than those in the non-single group (P < 0.05). The results of multivariate Logistic analysis showed: Plastic bronchitis (OR＾ = 1.618, 95%CI: 1.074 ~ 2.437), pleural effusion (OR＾ = 1.669, 95%CI: 1.074 ~ 2.593), mucosal erosion (OR＾ = 1.655, 95%CI: 1.112 ~ 2.464), long duration of fever (OR＾ = 1.578, 95%CI: 1.005 ~ 2.476), low serum albumin level (OR＾ = 1.605, 95%CI: 1.028 ~ 2.504), and high serum lactate dehydrogenase level (OR＾ = 1.554, 95%CI: 1.073 ~ 2.251) were all risk factors for increased BAL times in SP patients (P < 0.05). The regression equation: Logit (P) = -8.463 + plastic bronchitis × 0.481 + pleural effusion × 0.512 + mucosal erosion × 0.504 + duration of fever × 0.456 + serum albumin level × 0.473 + serum lactate dehydrogenase level × 0.441 (P < 0.05). When Logit (P) > 0.89, the area under the curve (AUC) was 0.903, the sensitivity was 88.71% (95%CI: 83.82% ~ 95.04%), and the specificity was 83.33% (95%CI: 73.20% ~ 90.88%).Conclusion The risk factors for the increase in the times of BAL in SP patients include plastic bronchitis, pleural effusion, mucosal erosion, prolonged fever, lower serum albumin levels, and higher serum lactate dehydrogenase levels. The regression equation constructed based on this shows good predictive value in the samples of this study, but its extrapolation needs to be verified by multi-center large sample studies.