| 周明英,周丽珍,陈翠丽,罗文慧,禹花,田畅霞.老年重症肺炎合并急性呼吸衰竭患者的转归及影响因素分析[J].中国临床保健杂志,2023,26(5):699-701. |
| 老年重症肺炎合并急性呼吸衰竭患者的转归及影响因素分析 |
| Investigation on the incidence of severe pneumonia combined with acute respiratory failure in the elderly and factors affecting clinical outcomes |
| 投稿时间：2023-07-07 |
| DOI：10.3969/J.issn.1672-6790.2023.05.027 |
| 中文关键词: 肺炎 呼吸功能不全 预后 危险因素 老年人 |
| 英文关键词: Pneumonia Respiratory insufficiency Prognosis Risk factors Aged 〖FL |
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| 中文摘要: |
| 目的 探究老年重症肺炎合并急性呼吸衰竭(ARF)患者的临床转归及其影响因素。方法 回顾性分析2020年10月至2022年10月丽水市中心医院收治的122例老年重症肺炎患者病历资料,研究患者ARF发病情况、病原体感染情况和临床转归,以及分析老年重症肺炎合并ARF患者的预后及危险因素。结果 122例老年重症肺炎患者中,有96例(78.69%)患者发生ARF,其中轻度、中度以及重度ARF分别为46例(47.92%)、34例(35.42%)以及16例(16.67%)；其中46例(47.92%)患者死亡,50例(52.08%)患者存活；在死亡患者中,有14例患者在住院期间死亡(30.43%),有32例患者在出院后随访过程中死亡(69.57%)；病毒以革兰阴性菌为主要病原体。死亡组患者病毒感染占39.62%、革兰阴性菌感染占35.85%；存活组上述病原体感染分别为25.58%、32.56%。单因素分析结果显示,死亡组患者中,年龄偏高、机械通气时间≤10 d、重度ARF、血乳酸清除率偏低、急性生理学与慢性健康状况评估Ⅱ(APACHE Ⅱ)评分高的患者占比较高(P<0.05)；多因素logistic回归分析结果显示,患者年龄≥80岁、重度ARF、血乳酸清除率≤10%、APACHE Ⅱ评分>25分是老年重症肺炎合并ARF患者不良转归的独立危险因素(P<0.05)。结论 老年重症肺炎患者合并ARF的发病率和病死率高；年龄≥80岁、重度ARF、血乳酸清除率≤10%、APACHE Ⅱ评分>25分、机械通气时间≤10 d与患者不良预后密切相关。 |
| 英文摘要: |
| Objective To explore the clinical outcome and its influencing factors in elderly patients with severe pneumonia complicated with acute respiratory failure (ARF).Methods A total of 122 elderly patients with severe pneumonia admitted to Lishui Municipal Central Hospital from October 2020 to October 2022 were retrospectively analyzed.The incidence of ARF,pathogen infection and clinical outcome were studied.The prognosis and risk factors of elderly patients with severe pneumonia complicated with ARF were analyzed.Results Among 122 elderly patients with severe pneumonia,96 cases (78.69%) developed ARF,among which 46 cases (47.92%),34 cases (35.42%) and 16 cases (16.67%) were mild,moderate and severe.Among them,46 patients (47.92%) died and 50 patients (52.08%) survived.Among the patients who died,14 patients died during hospitalization (30.43%) and 32 patients died during follow-up after discharge (69.57%).Viruses and Gram-negative bacteria were the main pathogens.In the death group,virus infection accounted for 39.62% and Gram-negative bacteria infection accounted for 35.85%.In the survival group,the infection rates were 25.58% and 32.56%,respectively.The results of univariate analysis showed that in the death group,the proportion of patients with high age,less than 10 days of mechanical ventilation,severe ARF,low blood lactate clearance rate,and high acute physiology and chronic health evaluation (APACHE Ⅱ) score above 25 was an independent risk factor for adverse outcomes in elderly patients with severe pneumonia complicated with ARF (P<0.05).The results of logistic regression analysis showed that age ≥80 years,severe ARF,blood lactate clearance rate ≤10%,and APACHE Ⅱ score>25 were independent risk factors for adverse outcomes in elderly patients with severe pneumonia complicated with ARF (P<0.05).Conclusions The incidences of ARF and mortality rate in elderly patients with severe pneumonia are high.Age≥80 years old,severe ARF,blood lactate clearance rate≤10 %,APACHE Ⅱ score>25 points,mechanical ventilation time≤10 d are closely related to the poor prognosis of patients. |
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