高龄患者肺部感染致多器官功能不全综合征的临床分析

Analysis of multiple organ dysfunction syndrome caused by pulmonary infection in very elderly patients

目的探讨高龄患者肺部感染致多器官功能不全综合征（MODSE）的临床特点。方法回顾性分析1998年8月~2010年8月住我院老年科42例因肺部感染引发MODSE高龄患者的临床资料,观察治疗前后存活患者及死亡患者APACHEⅡ评分变化。结果 42例患者均存在3种以上基础疾病,医院获得性肺炎37例,社区获得性肺炎5例,多种致病菌中以革兰阴性杆菌为主。治愈15例（35.71%）,死亡27例（64.29%）。2个器官功能衰竭者死亡2例（2/14）,3个器官功能衰竭者死亡16例（16/19）,4个以上器官功能衰竭者9例全部死亡。治疗前存活患者APACHEⅡ评分明显低于死亡患者;治疗后存活患者APACHEⅡ评分明显降低,而死亡患者变化不明显。结论高龄患者肺部感染常合并多种致病菌,院内获得性肺炎致病菌以铜绿假单胞菌为主,是引发MODSE的主要诱因,早期控制感染、合理使用抗生素并及时使用抗真菌药物、加强营养支持和免疫治疗对阻止各器官功能进一步序贯衰竭起重要作用,APACHEⅡ评分高的患者预后不良。

Objective To investigate clinical characteristics of MODSE in very elderly patients with lung infection. Methods Review clinical data of MODSE caused by lung infection of 42 very elderly patients（aged 80 years or older）,who were hospitalized in the department of geriatrics between August 1998 and August 2010,and observe the changes of APACHE Ⅱ scores of survivals and mortalities before and after treatment. Results Each of the 42 cases had more than 3 underlying diseases;37 cases were HAP（Hospital Acquired Pneumonia）,5 cases were CAP（Community Acquired pneumonia）,and most pathogenic bacteria were gram negative bacilli. The case fatality rate was related to the number of failure organs involved,the number of pathogenic bacteria, and the scores of APACHE Ⅱ. Conclusions Very elderly patients with lung infection are often suffering from multiple pathogenic bacteria. Most pathogenic bacteria of HAP were Pseudomonas aeruginosa,which was the main cause of MODSE. In order to prevent sequential organ failure,it is important to control the infection from an early stage,use antibiotics and antifugi rationally,reinforce nutritional support,and take immunotherapy. Prognosis mala is associated with high scores of APACHE Ⅱ.