老年肺炎患者并发心律失常的危险因素分析

Risk factors of cardiac arrhythmia in the elderly patients with pneumonia

目的探讨老年肺炎住院患者心律失常的发生情况及其危险因素,以期为老年肺炎患者发生心律失常的合理防治提供依据。方法回顾性分析238例老年肺炎住院患者的临床资料,采用多因素Logistic回归分析方法对64例并发心律失常患者（观察组）与174例未并发心律失常患者（对照组）进行比较分析。结果多因素Logistic逐步回归分析显示：年龄（OR=1.395,95%CI为1.005-1.935）、心血管病（OR=2.510,95%CI为1.179-5.354）、低氧血症（OR=2.499,95%CI为1.153-5.418）、酸中毒（OR=2.869,95%CI为1.175-7.005）、中-重度贫血（OR=3.397,95%CI为1.277-9.036）、电解质紊乱（OR=3.628,95%CI为1.292-9.374）、低射血分数（OR=5.140,95%CI为1.924-13.731）、机械通气（OR=5.433,95%CI为2.031-14.562）与老年肺炎患者并发心律失常有相关性。结论肺炎并发心律失常的危险因素有年龄、心血管疾病史、低氧血症、酸中毒、贫血、电解质紊乱、低射血分数以及机械通气。加强老年肺炎患者心律失常的监控,重视危险因素,早期预防和治疗,可提高患者生活质量。

Objective To identify the risk factors of cardiac arrhythmia in the elderly inpatients with pneumonia. Methods The clinical data of the inpatients with pneumonia in Beijing Geriatric Hospital between November 2009 and April 2013 were retrospectively analyzed. The patients were aged 75 and over. To examine the risk factors for cardiac arrhythmia, muhivariable logistic regression was performed. Results Of all the 238 patients, 26. 89% presented with cardiac arrhythmia. The variables significantly associated with cardiac arrhythmia included older age （ OR, 1. 395 ; 95% CI, 1. 005- 1. 935）, previously diagnosed cardiovascular disease （ OR, 2. 510; 95% CI, 1.179-5. 354）, PaO2 〈60 mmHg （ OR, 2. 499; 95% CI, 1. 153-5.418）, blood pH〈7.35 （OR, 2. 869; 95% CI, 1. 175-7. 005）, hemoglobin〈90 g/L （OR, 3. 397; 95% CI, 1. 277-9. 036）, electrolyte disturbance （OR, 3. 628; 95%CI, 1. 292-9. 374）, ejection fraction（EF） 〈 50% （OR, 5. 140; 95% CI, 1.924-13.731）, and mechanical ventilation （OR, 5.433; 95%CI, 2.031-14.562）. Conclusions Cardiac arrhythmia is common in elderly patients during hospitalization for pneumonia. Older age, preexisting cardiovascular disease, severity of pneumonia, anemia, electrolyte disturbance, and cardiac function are associated with the occurrence of arrhythmia. It is important to monitor and prevent the risk factors for cardiac arrhythmia.