老年社区获得性肺炎住院患者预后影响因素分析

Prognosis-influencing Factors in Elderly Inpatients with Community-Acquired Pneumonia

目的分析影响老年社区获得性肺炎(CAP)患者住院期间病死率的危险因素。方法回顾性研究2002—2006年我院收治的老年CAP患者(>65岁)的临床资料,比较死亡患者与存活患者的临床资料,并做单因素及多因素回归分析。结果242例老年CAP患者年龄(75±8)岁,64.5%的患者合并基础疾病,住院期间病死率为14.0%。死亡组和存活组患者的年龄和基础疾病等基线资料比较差异无统计学意义(P>0.05)。而死亡组患者入院时出现意识障碍、血肌酐升高、胸片示多肺叶或双侧病变和入院后出现严重并发症率与存活组间差异有统计学意义(P<0.05)。多因素回归分析表明患者入院时出现意识障碍、多肺叶或双侧病变和休克是老年CAP患者死亡的独立危险因素。结论老年CAP住院患者预后不佳,入院时患者出现意识障碍、多肺叶或双侧病变及休克是老年CAP患者死亡的独立危险因素,控制危险因素有助于探索干预措施以改善预后。

Objective To investigate the risk factors for death of elderly inpatients with community-acquired pneumonia(CAP).Methods The clinic data of elderly patients(>65y) with CAP hospitalized in our hospital from January 2002 to December 2006 were analyzed retrospectively.The clinical parameter of died cases and survival cases were compared,and both simple and multiple logistic regression analyses were conduced.Results A total of 242 patients aged(75±8) were included,of which 64.5 % were complicated by basic diseases,and the mortality during the period of hospitalization was 14.0 %.There was no significant difference between the death group and survival group in the fundamental materials such as age of patients and basic diseases(P>0.05),however in the ratios of disturbed consciousness occurrence at the admission,increased blood creatine,lesions of multi-lobi or both lungs,and serious complications after admission,there were significant differences(P<0.05).The multiple logistic regression analysis revealed that the disturbed consciousness occurrence at the admission,lesions of multi-lobi or both lungs,and shock were the independent risk factors in death of elderly CAP patients.Conclusion The prognosis of elderly patients with CAP is poor,and the disturbed consciousness occurrence at the admission,lesions of multi-lobi or both lungs,and shock were the independent risk factors in death of elderly CAP patients.So control of the risk factors is conductive to get intervention for improvement of prognosis.