108例重症社区获得性肺炎患者预后相关危险因素分析

Analysis of risk factors of 108 patients with severe community-acquired pneumonia

目的探讨重症社区获得性肺炎死亡相关危险因素,为临床救治提供帮助。方法收集入住呼吸科及综合ICU的重症社区获得性肺炎患者108例,根据预后情况分为死亡组和存活组,通过单因素分析和多因素logistic回归分析,筛选其死亡相关危险因素。结果 108例重症社区获得性肺炎病死率为45.3%(49/108)。单因素分析提示年龄、基础疾病数量、多器官功能障碍、血浆白蛋白水平、血清降钙素原、低氧合指数及血乳酸浓度等因素,可能与重症社区获得性肺炎预后相关(P<0.05),而性别、呼吸频率、血白细胞计数、血糖、总胆红素、长期卧床、收缩压等因素可能与预后无关(P>O.05);多因素logistic回归模型分析显示年龄≥83.5岁、血乳酸≥5.06 mmol/L、器官功能损害数量多以及氧合指数<200 mm Hg等可能为重症社区获得性肺炎死亡的独立危险因素。结论高龄(≥83.5岁)、多器官功能障碍、低氧合指数(<200 mm Hg)及高血乳酸(≥5.06 mmol/L)可能为重症社区获得性肺炎死亡的主要危险因素。

Objective To investigate the risk factors associated with the mortality of patients with severe pneumonia . Methods 108 patients with severe community-acquired pneumonia were divided into the death group and the survival group according to their prognosis. Univariate analysis （ chi-square test and rank sum test） and mult-ivariate Logistic regression were used for statistics analysis. Results The mortality was 45. 3% （49/108） in all 108 patients with severe pneumonia. Univariate analysis suggested that age, number of basic diseases, multiple organ dys-function, plasma albumin levels, serum procalcitonin, low oxygenation index and blood lactate levels might be associ-ated with the prognosis of severe pneumonia, while sex, respiratory frequency, white blood cell count, blood glucose, total bilirubin, long-term lie in bed, systolic pressure and other factors had nothing to do with the prognosis. Multi-variable logistic regression model analysis showed that older age （≥83. 5 years）, blood lactate levels （≥5. 06 mmol/L）, organ damage quantity and low oxygenation index （ 〈200 mmHg） were the independent risk factors for severe community-acquired pneumonia. Conclusion Older age （≥83. 5 years）, blood lactate levels （≥5. 06 mmol/L） and organ damage quantity and low oxygenation index （ 〈200 mmHg） are the independent risk factors for severe community-acquired pneumonia.