老年呼吸机相关肺炎患者死亡的危险因素

Risk factors for death in elderly patients with ventilator-associated pneumonia

目的分析老年呼吸机相关肺炎(VAP)患者死亡的危险因素。方法调查2011年4月—2017年2月某院年龄≥60岁且发生VAP的患者,收集患者的临床资料,包括基本情况、感染情况、预后等,并对其死亡的危险因素进行分析。结果共有老年VAP患者682例,198例患者死亡,病死率为29.03%。APACHEⅡ评分>15分(OR=2.482,95%CI=1.473~4.183)、机械通气时间>15 d(OR=2.526,95%CI=1.661~3.840)、多重耐药菌感染(OR=3.379,95%CI=2.008~5.686)、真菌感染(OR=3.414,95%CI=1.830~6.370)、使用糖皮质激素(OR=2.075,95%CI=1.265~3.403)、血清清蛋白浓度<35 g/L(OR=2.129,95%CI=1.386~3.268)、器官损伤数目≥3个(OR=3.438,95%CI=2.165~5.459)、血糖≥10 mmol/L(OR=1.744,95%CI=1.106~2.751)等8个因素均为老年VAP患者死亡的独立危险因素。结论老年VAP患者死亡与多种因素有关,临床应采取以干预主要危险因素为主的综合防控措施,降低其病死率。

Objective To analyze risk factors for death in elderly patients with ventilator-associated pneumonia(VAP).Methods Patients aged≥60 years and with VAP in a hospital from April 2011 to February 2017 were surveyed,clinical data of patients,including basic condition,infection status,and prognosis were collected,risk factors for death were analyzed.Results There were 682 elderly patients with VAP,198(29.03%)died.There were 8 independent risk factors for death in elderly VAP patients:APACHE II score>15 points(OR,2.482[95%CI,1.473-4.183]),mechanical ventilation>15 days(OR,2.526[95%CI,1.661-3.840]),multidrug-resistant organism infection(OR,3.379[95%CI,2.008-5.686]),fungal infection(OR,3.414[95%CI,1.830-6.370]),glucocorticoid use(OR,2.075[95%CI,1.265-3.403]),serum albumin concentration<35 g/L(OR,2.129[95%CI,1.386-3.268]),number of organ damage≥3(OR,3.438[95%CI,2.165-5.459]),and blood sugar≥10 mmol/L(OR,1.744[95%CI,1.106-2.751]).Conclusion Mortality of elderly patients with VAP is related to multiple factors,comprehensive prevention and control measures should be taken to interfere the main risk factors and reduce the mortality.