慢性阻塞性肺疾病急性加重期合并肺部感染患者死亡的影响因素分析

Influencing Factors of Death in Patients with AECOPD Complicated with Pulmonary Infection

目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)合并肺部感染患者死亡的影响因素。方法选取浙江大学医学院附属第一医院急诊科2012年1月—2016年5月间收治的AECOPD合并肺部感染死亡患者88例(研究组)与同期未死亡患者88例(对照组)作为研究对象。参考相关文献和临床上的观察结果,选择出AECOPD合并肺部感染患者死亡的可能影响因素共15项,包括性别、年龄、职业、体质指数、吸烟、病程、住院时间、机械通气、高同型半胱氨酸血症、合并糖尿病、低蛋白血症、两种或两种以上微生物感染、两种或两种以上器官功能衰竭、广谱抗生素使用天数及抗生素的联合使用。采用单因素logistic和多因素logistic回归进行统计学分析。结果单因素logistic回归分析结果显示,年龄、吸烟、机械通气、住院时间、高同型半胱氨酸血症、合并糖尿病、低蛋白血症、两种或两种以上微生物感染、两种或两种以上器官功能衰竭及抗生素的联合使用对AECOPD呼吸衰竭肺部感染患者死亡的影响差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,住院时间、合并糖尿病、低蛋白血症、两种或两种以上器官功能衰竭、抗生素的联合使用对AECOPD呼吸衰竭肺部感染患者死亡的影响差异有统计学意义(P<0.05)。结论住院时间、合并糖尿病、低蛋白血症及两种或两种以上器官功能衰竭是AECOPD合并肺部感染患者死亡的危险因素,抗生素的联合使用是保护因素,提早对这些危险因素进行有效的预防和控制,可以改善患者预后。

Objective To investigate the influencing factors of death in patients with AECOPD complicated with pulmonary infection. Methods Selecting 88 deceased patients（research group） with AECOPD complicated with pulmonary infection who received treatment in the First Affiliated Hospital of Zhejiang University School of Medicine from January,2012 to May,2016,and selecting another 88 cured patients（control group） under the same condition. According to references and clinical observed results,choosing 15 factors that were more likely to influence death in patients with AECOPD complicated with pulmonary infection. 15 factors were gender,age,occupation,body mass index,smoking,duration of disease,length of stay,mechanical ventilation,hyperhomocysteinemia,complicated with diabetes,hypoproteinemia,two or more than two kinds of microorganisms infection,two or more than two kinds of organ failure,number of days using broad-spectrum antibiotics,two and more than two kinds of organ failure,number of days using broad-spectrum antibiotics and combined use of antibiotics. Univariate and multivariate logistic regression analysis were conducted. Results Univariate logistic regression analysis shows that the influences of age, smoking, mechanical ventilation,length of stay,hyperhomocysteinemia,complicated with diabetes,hypoproteinemia,two or more than two kinds of microorganisms infection,two and more than two kinds of organ failure and combined use of antibiotics on death in patients with AECOPD complicated with pulmonary infection are statistically significant（P〈 0. 05）; the multivariate logistic regression analysis shows that the influences of length of stay,hyperhomocysteinemia,complicated with diabetes,hypoproteinemia,two or more than two kinds of organ failure and combined use of antibiotics on death of patients with AECOPD complicated with pulmonary infection are statistically significant（P 〈0. 05）. Conclusion Length of stay,complicated with diabetes,hypoproteinemia and two or more than two kinds of organ failure are the risk factors of death in patients with AECOPD complicated with pulmonary infection,and combined use of antibiotics is the protective factor. Early prevention and control of these risk factors could improve the prognosis in patients and reduce case fatality rate.