凝血功能指标早期乳酸清除率对老年危重肺炎患者死亡的影响

Influence of coagulation function and early lactate clearance rate on death of elderly patients with severe pneumonia

目的探讨凝血功能指标、早期(发病6 h内)乳酸清除率(6 h LCR)对老年危重肺炎(SP)患者死亡的影响。方法回顾性分析2018年9月至2020年8月间医院呼吸内科收治的82例老年SP患者的临床资料,根据住院28 d的死亡情况,将患者分为存活组(53例)、死亡组(29例)。分析老年SP患者病原菌的分布特点,比较2组患者的基本资料、生化指标、致病菌耐药情况、6 h LCR、凝血功能状态,分析老年SP患者死亡的独立危险因素。结果82例痰液标本中,细菌培养阳性率为62%,其中革兰阴性菌(G-)占74%、革兰阳性菌(G+)占19%、真菌占5%。G-菌前三位依次是肺炎克雷伯菌(26%)、大肠埃希菌(22%)、鲍曼不动杆菌(18%)。年龄、基础疾病≥3种、长期卧床、耐多药菌感染、吞咽障碍、白细胞、C反应蛋白(CRP)、降钙素(PCT)、白蛋白(ALB)、血乳酸、6 h LCR、急性生理和慢性健康状况(APACHE)Ⅱ评分、活化部分凝血活酶时间(APTT)与老年SP患者死亡显著相关(P<0.05)。Logistic回归分析显示,APACHEⅡ评分、APTT是影响老年SP患者死亡的危险因素,而6 h LCR、ALB则是保护因素(P<0.05)。结论老年SP患者感染以G-菌为主,且存在多耐药菌感染,其预后与早期LCR及凝血功能密切相关,动态监测凝血功能指标、血乳酸水平变化可实时评估病情严重程度、感染控制及预后。

Objective To explore the influence of coagulation function and early(onset within 6 hours)lactate clearance rate(6 h LCR)on death of elderly patients with severe pneumonia(SP).Methods Retrospective analysis was performed on the clinical data of 82 elderly SP patients admitted to the Respiratory Department of the hospital from September 2018 to August 2020.According to the death rate within 28 days in the hospital,the patients were divided into the survival group(n=53)and the death group(n=29).The distribution characteristics of pathogenic bacteria in elderly SP patients were analyzed,and the basic data,biochemical indexes,pathogenic bacteria resistance,6 h LCR,and state of coagulation function in the two groups were compared,and the independent risk factors of death in elderly SP patients were analyzed.Results Among the 82 sputum samples,the positive rate of bacterial culture was 62%,among which Gram negative bacteria(G-)accounted for 74%,Gram positive bacteria(G+)accounted for 19%,and fungus accounted for 5%.Klebsiella pneumoniae(26%),Escherichia coli(22%)and Acinetobacter baumannii(18%)were the top three bacteria.Age,kind of basic diseases≥3,long-term bed rest,multi-drug resistant bacterial infection,dysphagia,WBC,CRP,PCT,ALB,blood lactic acid,6 h LCR,APACHEⅡscore and APTT were significantly correlated with death in elderly SP patients(P<0.05).Logistic regression analysis showed that APACHEⅡscore and APTT were risk factors for death of elderly SP patients,while 6 h LCR and ALB were protective factors(P<0.05).Conclusions The elderly patients with SP were mainly G-bacteria with multi-drug resistant bacterial infection,whose prognosis was closely related to early LCR and coagulation function.Dynamic monitoring of coagulation function indicators and changes in blood lactic acid level can evaluate the severity of the disease,infection control and prognosis in real time.