老年吸入性肺炎预后相关影响因素分析

Analysis of related factors affecting prognosis of elderly patients with aspiration pneumonia

目的探讨老年吸入性肺炎患者病原菌感染特点及其影响因素,为该病的防治提供临床依据。方法回顾性分析2016年1月-2020年3月华东医院急诊内科收治的老年吸入性肺炎患者134例的临床资料。收集患者入院时的一般基础情况(性别、年龄、是否合并基础疾病、住院天数)、实验室指标(白细胞数、中性粒细胞比例、淋巴细胞比例、中性粒细胞/淋巴细胞比值(NLR),C-反应蛋白、降钙素原PCT、痰液病原菌阳性率、血清白蛋白、尿素氮、肌酐),以及入院时的CURB-65评分和急性生理学与慢性健康状况评分(APACHEII评分)。以患者入院后第90天为节点,根据预后分为好转组及死亡组,并对2组上述资料进行比较。结果134例老年吸入性肺炎患者中,合并基础疾病的有131例(97.76%),最常见的为心脑血管疾病。其中合并2种以上(不包括2种)基础疾病的有54例(40.3%)。在134例患者中有45例患者的痰液中检测出病原菌,检出率为33.58%。其中病原菌以革兰阴性菌为主(37例,74%),其次为革兰阳性菌(6例,12%)和真菌(17例,4%)。2组的年龄、性别、淋巴细胞、住院天数及合并症差异无统计学意义(P>0.05),但好转组白细胞数、中性粒细胞、NLR、CRP、PCT、肌酐、尿素氮、CURB-65、APACHE-II和病原菌阳性率低于死亡组(P<0.05),白蛋白高于死亡组(P<0.05)。COX回归分析显示,CURB-65和APACHEII评分是老年吸入性肺炎患者死亡的的独立危险因素(OR=3.577,P=0.032;OR=1.186,P=0.001)。结论CURB-65和APACHEII评分可望用来判断老年患者吸入性肺炎的严重程度及预后。

Objective To investigate the characteristics and influencing factors of pathogenic bacteria in elderly patients with aspiration pneumonia,and provide clinical evidence for the prevention and treatment of the disease.Methods The clinical data of 134 elderly patients with aspiration pneumonia admitted to the Department of Emergency Medicine of Huadong Hospital from January 2016 to March 2020 were retrospectively analyzed.The general basic information of the patient(gender,age,underlying diseases,length of hospital stay),laboratory indexes[white blood cell count,neutrophil ratio,lymphocyte ratio,neutrophil/lymphocyte ratio(NLR),C-reactive protein,procalcitonin PCT,sputum pathogen positive rate,serum albumin,urea nitrogen,creatinine],as well as the CURB-65 score and Acute Physiology and Chronic Health(APACHEⅡ)score at admission were collected.According to the prognosis on the 90 th day after admission,the patients were divided into improvement group and death group,and the above data of the two groups were compared.Results Among the 134 elderly patients with aspiration pneumonia,131(97.76%)had underlying diseases,and the most common was cardiovascular and cerebrovascular diseases.Among them,54 cases(40.3%)had more than two kinds of underlying diseases.Pathogenic bacteria were detected in 45 cases,accounting for 33.58%.The main pathogenic bacteria were gram-negative bacteria(37 cases,74%),followed by gram-positive bacteria(6 cases,12%)and fungi(17 cases,4%).There was no significant difference in age,gender,lymphocyte,length of hospital stay and complications between the two groups(P>0.05),but the number of leukocytes,neutrophils,NLR,CRP,PCT,creatinine,urea nitrogen,CURB-65 score,APACHEⅡscore and positive rate of pathogens of the improved group were lower than those of the dead group(P<0.05),and the albumin was higher than that of the dead group(P<0.05).COX regression analysis showed that CURB-65 and APACHEⅡscores were independent risk factors for death in elderly patients with aspiration pneumonia(OR=3.577,P=0.032;OR=1.186,P=0.001).Conclusion CURB-65 and APACHEⅡscores may be used to judge the severity and prognosis of aspiration pneumonia in elderly patients..