162例成人重症肺炎临床特点及死亡危险因素分析

Analysis of clinical characteristics and risk factors for death of 162 adult patients with severe pneumonia

目的探讨成人重症肺炎的临床特点及死亡危险因素以指导临床救治。方法回顾性分析我院2006年1月至2007年12月收治的162例成人重症肺炎患者的临床病历资料。结果 162例成人重症肺炎患者中,男98例,女64例,平均年龄(69.7±15.0)岁;死亡126例,存活36例,总病死率77.8%;死亡组平均年龄[(73.6±12.5)岁]明显高于存活组[(55.9±15.9)岁](P<0.05);死亡组患者平均住院天数(12.0±13.4)天,明显短于存活组(19.6±13.7)天(P<0.05);死亡组患者住院天数不超过7天的百分比明显高于存活组(P<0.05);年龄≥65岁、3个及3个以上器官受累及营养支持治疗不充分的相对危险度OR值及其95%可信区间分别是6.786[2.731～16.858]、3.114[1.224～7.917]及3.866[1.528～9.780],P<0.05。结论年龄≥65岁、器官受累数大于3个及不充分的营养支持治疗是成人重症肺炎患者死亡的危险因素;积极预防及治疗受累脏器以及充分的营养支持可降低成人重症肺炎患者的病死率;是否合并慢性阻塞性肺疾病(COPD)及消化道出血、休克和肺叶受累数量尚不能认为是成人重症肺炎的死亡危险因素。

Objective To investigate clinical features and risk factors for death in adult patients with severe pneumonia to guide clinical work.Methods A total of 162 severe pneumonia patients from Jan.2006 to Dec.2007 admitted to our hospital were enrolled and studied retrospectively.Results In 162 severe pneumonia patients,there were 98 males and 64 females and the mean age was(68.1±15.8)years old,126 patients died and 15 patients survived.The rough mortality was 77.8 %.The mean age of the dead group([(73.6±12.5)year] was statistically older than that of the survival group [(55.9±15.9)year](P<0.05).The mean hospitalized days of the dead group [(12.0±13.4)d] were significantly shorter than that of the survival group [(19.6±13.7)d](P<0.05).The percentage of less than seven days hospitalized of the dead group was statistically higher than that of the survival group.Odds ratios(OR)and 95% confidence intervals(CI)of age greater than or equal to 65 years old,number of organs injured greater than or equal to 3 and insufficient nutrient supporting treatment were 6.786 [2.731～16.858],3.114 [1.224～7.917] and 3.866 [1.528～9.780] respectively(P<0.05).Conclusions Age greater than or equal to 65 years old,number of organs injured greater than 3 and insufficient nutrient supporting treatment are risk factors for death in adult severe pneumonia.Sufficient nutrient supporting treatment,prevention of multi-organ injury may reduce its mortality.Combined with COPD,complications of shock,gastrointestinal hemorrhage,and number of the lung labors involved may not be risk factors for death in adult patients with severe pneumonia.