摘要
目的探讨入院营养状况对老年社区获得性肺炎(CAP)严重程度及临床预后的影响。方法选取2018年1月至2018年9月在首都医科大学附属北京友谊医院医疗保健中心内科住院的老年CAP患者150例为研究对象。入院24 h内应用肺炎严重指数(PSI)量表进行肺炎严重程度评估,根据肺炎严重程度分为非高危肺炎组(99例)与高危肺炎组(51例)。72 h内应用营养风险筛查2002(NRS2002)量表进行营养状况调查。记录并比较2组患者基本资料、实验室数据及临床预后等情况。应用SPSS 22.0软件进行统计分析。根据数据类型,组间比较采用t检验、秩和检验或卡方检验。多因素logistic逐步回归分析探讨CAP患者发生高危肺炎的影响因素。结果多因素logistic回归分析显示,营养风险评分增高(OR=0.481,95%CI 0.231~0.999;P=0.049)、红细胞体积分布宽度(RDW)增加(OR=2.400,95%CI 1.302~4.425;P=0.005)、心力衰竭(OR=7.854,95%CI 1.086~56.784;P=0.041)、口腔缺齿/义齿(OR=19.84,95%CI 1.366~288.219;P=0.029)、血尿素氮增高(OR=2.050,95%CI 1.219~3.446;P=0.007)和日常生活能力评分减低(OR=0.452,95%CI 0.237~0.862;P=0.016)是老年CAP患者发生高危肺炎的影响因素(P<0.05)。在所有患者中,合并营养风险者与营养正常者30 d临床预后(P=0.016)及出院转归(P=0.012)比较,差异有统计学意义,其中合并营养风险的患者预后较差。结论老年CAP住院患者高危肺炎发生率高,预后差,临床上需注意营养风险、心功能不全、口腔卫生以及日常生活能力降低等情况的发生。
Objective To investigate the effect of nutritional status on the severity and clinical prognosis of community acquired pneumonia(CAP)in the elderly.Methods One hundred and fifty elderly CAP patients hospitalized in our department from January 2018 to September 2018 were selected.The severity of pneumonia was assessed with pneumonia severity index(PSI)within 24 h after admission,and according to the severity of pneumonia,the patients were divided into non-high-risk pneumonia group(n=99)and high-risk pneumonia group(n=51).The nutritional status was evaluated with nutritional risk screening 2002(NRS2002)scale within 72 h.Their basic data,laboratory indices and clinical prognosis were recorded and compared between the 2 groups.SPSS statistics 22.0 was used for statistical analysis.According to the data type,Student′s t test,rank sum test or Chi-square test was used for comparison between groups.Multivariate logistic stepwise regression analysis was used to investigate the influencing factors of high-risk pneumonia in CAP patients.Results Multiple logistic regression analysis showed that increased nutritional risk score(OR=0.481,95%CI 0.231-0.999,P=0.049)and red blood cell volume distribution width(OR=2.400,95%CI 1.302-4.425,P=0.005),heart failure(OR=7.854,95%CI 1.086-56.784,P=0.041),oral missing teeth/denture(OR=19.84,95%CI 1.366-288.219,P=0.029),blood urea(OR=2.050,95%CI 1.219-3.446,P=0.007)and lower Barthel score for ability of daily life score(OR=0.452,95%CI 0.237-0.862,P=0.016)were influencing factors for high-risk pneumonia in elderly CAP patients(P<0.05).In all these patients,there were significant differences in 30-day clinical prognosis(P=0.016)and discharge outcome(P=0.012)between those with nutritional risk and those with normal nutrition.The prognosis of those with nutritional risk was worse.Conclusion The elderly CAP patients are prone to high-risk pneumonia and poor prognosis.Therefore,special attention should be paid to the elderly with nutrition risk,cardiac insufficiency,oral hygiene and decline of daily living ability.
作者
郝小飞
姜春燕
HAO Xiao-Fei;JIANG Chun-Yan(Department of Internal Medicine, Health Care Centre, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China)
出处
《中华老年多器官疾病杂志》
2020年第5期350-354,共5页
Chinese Journal of Multiple Organ Diseases in the Elderly