患者，女，49岁。咳嗽，咳黄脓痰，伴发热4天。胸片:两肺纹理增多，紊乱。血常规：WBC21x109/L,CRP35.27mg/L。血气分析:pH7.30,PaC0266mmHg,Pa0250mmHg,AB24mmol/L,SB24mmol/L,BE1mmol/L,C02CP19mmol/L。该患者的诊断是

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