老年2型糖尿病合并社区获得性肺炎住院患者的临床特点

The clinical analysis of community-acquired pneumonia in elderly patients in hospital with type 2 diabetes mellitus

目的对老年2型糖尿病合并社区获得性肺炎(community acquired pneumonia,CAP)住院患者的临床资料进行回顾性分析,并探讨其临床特点,提出防治措施。方法将复兴医院2008年10月至2010年10月收治的188例老年CAP患者,依据有无2型糖尿病分为单纯CAP组(对照组)64例,糖尿病合并CAP组(观察组)124例,将观察组按糖化血红蛋白(HbA1c)水平分为2个亚组,A组(HbA1c<7.0%)67例,B组(HbA1c≥7.0%)57例,比较其基本临床情况、血糖水平、治疗及转归。结果 B组应用≥3种抗生素25例(43.86%),应用抗生素时间为(25.00±4.21)d;发生电解质紊乱23例(40.35%),发生血红蛋白下降23例(40.35%),发生血清白蛋白下降25例(43.86%),继发真菌感染18例(31.58%),转ICU或CCU治疗14例(24.56%),平均住院(32.75±4.37)d,且上述指标均高于对照组及A组,3组比较差异有统计学意义(P<0.01)。结论老年2型糖尿病血糖控制未达标合并CAP患者病情重,预后差,临床医师应尽快控制血糖至达标,及时、有效、合理地应用抗生素,积极寻求病原学支持,改善营养状况,加强宣教。

Objective To provide information on clinical characteristics as well as prevention and treatment measures of community-acquired pneumonia（CAP）in elder patients in hospital with type 2 diabetes mellitus.Methods We consecutively collected 188 elderly patients with CAP who were admitted to FuXing Hospital from Oct 2008 to Oct 2010 and stratified them into two groups based on their diabetes co-morbidity.124 patients were in ＇CAP with diabetes group＇ and 64 were in CAP only group.We then divided the ＇CAP with diabetes＇ group into two subgroups： A with HbA1c7.0% and B with HbA1c≥7.0%.67 and 57 patients were in subgroup A and B respectively.We then comprehensively compared differences on clinical and laboratory profiles,treatment strategies and prognosis among these groups and subgroups.Results Twenty-five（43.86%） patients in subgroup B had used more than 3 types of antibiotics and stayed longer in hospital.The mean treatment duration was（25.00±4.21）days in subgroup B.Meanwhile,23（40.35%）patients had electrolyte disturbance,23（40.35%）and 25（43.86%）had decreased hemoglobin or albumin levels respectively and 18（31.58%）patients suffered secondary fungal infection in subgroup B.14 more patients（24.56%）were transferred to ICU or CCU and had longer length of stay（LOS）in subgroup B,the mean LOS was（32.75±4.37）days.The differences on above mentioned clinical features were statistically significant among three study groups.Conclusions Hospitalized CAP elder patients with poorly controlled glucose level had severe disease condition and prognosis.The suggested treatment strategies should include timely using effective antibodies,actively gathering laboratory etiology evidence,closely monitoring the patient＇s conditions,placing strict control over patients＇ glucose level,improving nutrition status and enhancing health education.