影响老年重症肺炎患者预后的相关因素分析

Factors influencing prognosis of elderly patients with severe pneumonia

目的分析影响老年重症肺炎患者预后的相关因素。方法选取2018年4月至2019年4月在该院住院治疗的154例老年重症肺炎患者为对象进行分析,根据治疗结束后是否存活将其分为存活组(n=67)和死亡组(n=87)。采用单因素和多因素Logistic回归分析影响患者预后的相关因素,同时分析两组的病原学分布情况。结果经单因素分析显示,年龄、肺炎严重指数(PSI)评分、急性生理学与慢性健康评定标准Ⅱ评分(APACHE II)、降钙素原、机械通气、体内留置导管情况、餐后2 h内平卧等是可能影响老年重症肺炎患者的相关因素(P<0.05);多因素Logistic回归分析显示,PSI评分、APACHE II评分、机械通气、餐后2 h内平卧是影响老年重症肺炎患者的危险因素(P<0.05)。154例患者中共培养出195株病原菌,包括革兰阴性菌137株(70.26%),革兰阳性菌42株(21.54%),真菌16株(8.21%);死亡组感染革兰阴性菌、革兰阳性菌、混合菌的人数明显高于存活组(P<0.05)。结论老年重症肺炎患者体内病原菌分布甚广,其中以鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌感染患者预后最差,而影响患者预后的因素主要有APACHE II评分、机械通气、餐后2 h平卧等,因此临床要加强对老年重症肺炎患者死亡危险因素的分析,以便及时采取有效措施进行干预,提高患者的存活率。

【Objective】To analyze the related factors influencing the prognosis of the elderly patients with severe pneumonia.【Methods】A total of 154 elderly patients with severe pneumonia hospitalized in our hospital from April 2018 to April 2019 were selected for analysis.According to whether they survived after treatment,they were divided into survival group(n=67)and death group(n=87).Single factor and multi-factor Logistic regression analysis were used to analyze the factors influencing the prognosis of patients,and the distribution of pathogens in the two groups was analyzed.【Results】The single factor analysis showed that age,pneumonia severity indexpneumonia severity index score(PSI)score,acute physiology and chronic health evaluation II(APACHE II)score,procalcitonin,mechanical ventilation,indwelling catheter in the body,lying flat within 2 hours after meal were the related factors that may affect the elderly patients with severe pneumonia(P<0.05);multi-factor Logistic regression analysis showed that PSI score,APACHE II score,mechanical ventilation and lying flat within 2 hours after meal were the risk factors of severe pneumonia in the elderly(P<0.05).A total of 195 strains of pathogens were cultured in 154 patients,including 137 strains of Gramnegative bacteria(70.26%),42 strains of Gram-positive bacteria(21.54%)and 16 strains of fungi(8.21%);the number of Gramnegative bacteria,Gram-positive bacteria and mixed bacteria in the dead group was significantly higher than that in the living group(P<0.05).【Conclusion】The distribution of pathogenic bacteria in the elderly patients with severe pneumonia is very wide,among which Acinetobacter baumannii,Pseudomonas aeruginosa and Klebsiella pneumoniae infection have the worst prognosis,and the main factors affecting the prognosis of the patients are APACHE II score,mechanical ventilation,lying on the back 2 hours after meal,etc.Therefore,it is necessary to strengthen the analysis of death risk factors of the elderly patients with severe pneumonia in order to take effective measures in time for improving the survival rate of patients.