老年重症肺炎的病原学特点及死亡危险因素的分析

Pathogenic characteristics and risk factors of elderly patients with severe pneumonia

目的对我院2011年1月到2017年6月之间我院收治老年重症肺炎患者的临床资料进行回顾性分析,分析老年重症肺炎的病原学特点和死亡危险因素。方法采用回顾性的调查研究的方法,分析老年重症肺炎患者的临床资料特点,比较存活组和死亡组两组的致病菌及危险因素。结果共符合纳入标准和排除标准的共有92名,存活57名,死亡组35名,老年重症肺炎的病死率为38.0%,致病菌主要是以革兰阴性菌为主。死亡组的鲍曼不动杆菌的感染率为48.6%,显著高于存活组的21.1%(P<0.05);死亡组合并真菌的感染率为37.1%,同样显著高于存活组的7.0%(P<0.05)。两组在肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌、嗜麦芽假单胞菌和肺炎链球菌感染方面差异无统计学意义(P>0.05)。存活组和死亡组两组在年龄、吸烟史、合并糖尿病、脑卒中、心衰或心梗、机械通气、急性肾损伤、多肺叶病变和APAECHEⅡ评分方面差异有统计学意义(P<0.05)。而在性别、合并高血压和胸腔积液方面无统计学意义(P>0.05)。logistic多因素回归分析结果显示,吸烟史、糖尿病、脑卒中、心衰或心梗、APAECHEⅡ评分和机械通气是老年重症肺炎的死亡的独立危险因素。结论老年重症肺炎患者病原菌分布较广,以革兰阴性菌为主,鲍曼不动杆菌感染和合并真菌感染预后较差;吸烟史、糖尿病、脑卒中、心衰或心梗、APAECHEⅡ评分和机械通气是老年重症肺炎的死亡的独立危险因素。

Objective To study the pathogenic characteristics and risk factors of elderly patients with severe pneumonia from January 2011 to June 2017.Methods A retrospective study was conducted to assess the clinical characteristics of elderly patients with severe pneumonia.The pathogenic bacterium and the risk factors were compared between the survival group and the death group.Results There were 92 patients met to the inclusive criteria and excluding criteria.Among them,57 patients were survival,and 35 patients were dead.The fatality rate was 38.0%.The main pathogenic bacterium was gram negative bacilli.The incidence of acinetobacter baumannii in the death group was 48.6%,which was significantly higher than 21.1%in the survival group(P<0.05).The fungal infection rate was 37.1%in the death group,which was significantly higher than 7.0%in the survival group(P<0.05).Their age,smoking history,complication of diabetes,stroke,cardiac failure,myocardial infarction,APAECHEⅡscore and mechanical ventilation in the death group were significantly higher than that in the survival group(P<0.05),but their gender,complication of hypertension and incidence of pleural effusion had no significance(P>0.05).Multiple factors analysis results showed that smoking history,complication of diabetes,stroke,cardiac failure,myocardial infarction,APAECHEⅡscore and mechanical ventilation were the risk factors of elderly patients with severe pneumonia.Conclusion The gram negative bacilli are the main pathogens in elderly patients with severe pneumonia.The acinetobacter baumannii and fungal infection often indicate poor prognosis.Smoking history,complication of diabetes,stroke,cardiac failure,myocardial infarction,APAECHEⅡscore and mechanical ventilation are the risk factors of elderly patients with severe pneumonia.