老年人重症肺炎预后影响因素分析

Analysis of prognostic factors of severe pneumonia in the elderly patients

目的探讨老年重症肺炎预后影响因素,以采取相应措施改善预后。方法回顾性分析2000年2月至2011年5月入住我院的82例老年重症肺炎患者的临床资料。结果 82例患者中医院获得性肺炎67例,社区获得性肺炎15例;存活23例,死亡59例,死亡组年龄明显大于存活组[(84.67±3.58)岁vs(76.25±6.87)岁,P<0.05]。死亡患者治疗前APACHEⅡ评分明显高于存活患者,治疗后存活患者APACHEⅡ评分(16.32±4.24)明显降低,而死亡患者(28.53±2.71)无明显变化,两者比较差异有统计学意义(P<0.01)。受累器官越多,病死率越高。结论高龄、医院获得性肺炎、基础疾病多、多器官受累、APACHEⅡ评分高是影响老年重症肺炎患者预后的主要危险因素。早期足量抗生素经验性治疗,加强营养支持和免疫治疗,早期预防重要脏器功能衰竭,及时应用机械通气及连续性静脉-静脉血液滤过治疗可降低老年重症肺炎病死率。

Objective To investigate the prognostic factors of severe pneumonia in the elderly,and to take appropriate measures to improve the prognosis. Methods Analyze the clinical data from 82 cases of elderly hospital patients with severe pneumonia admitted from February 2000 to May 2011. Results Among the 82 cases,there were 67 cases of hospital-acquired pneumonia and 15 cases of community acquired pneumonia,59 patients died while 23 survived. The age of the death group was significantly greater than that of the survival group [ （84.67±3.58） vs （76.25±6.8）,P〈0.05]. APACHE Ⅱ scores of the death group were significantly higher than that of the survival group. The APACHE II scores of the survival group were significantly reduced after treatment （16.32±4.24）,while that of the death group remained the same （28.53±2.71）. Conclusions Old age,hospital-acquired pneumonia,underlying diseases and multi-organ involvement,high APACHE Ⅱ score are the major risk factors that influence the prognosis of elderly patients with severe pneumonia. Adequate early empirical antibiotic therapy,nutritional support and immune therapy, early prevention of major organ failure, mechanical ventilation timely and CVVH treatment can reduce the mortality of elderly patients with severe pneumonia.