老年人吸入性肺炎的危险因素及预后影响因素分析

Risk factors and prognostic factors of aspiration pneumonia in the elderly

目的分析老年人吸入性肺炎的危险因素及预后影响因素。方法选取50例老年人吸入性肺炎患者作为研究组,根据患者预后不同分为好转组(43例)和恶化/死亡组(7例);另选取50例老年人非吸入性肺炎患者作为对照组。分析老年人吸入性肺炎的危险因素及预后影响因素。结果研究组年龄、入院时急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分及男性、意识障碍、吞咽功能障碍、咳嗽反射减弱、隐性误吸、长期卧床、留置胃管、胃食管返流病史、低蛋白血症、牙周疾病、脑卒中病史、糖尿病病史、冠心病病史、高血压病史占比均高于对照组,差异有统计学意义(P<0.05)。好转组肺炎严重指数(PSI)评分(103.73±7.82)分、白细胞计数(12.81±0.48)×10^(9)/L及C反应蛋白(56.19±9.81)mg/L均低于恶化/死亡组的(131.85±13.74)分、(15.71±1.05)×10^(9)/L、(82.38±8.62)mg/L,血清白蛋白(26.19±3.86)g/L高于恶化/死亡组的(22.38±2.18)g/L,差异有统计学意义(P<0.05)。结论老年人发生吸入性肺炎可与多种危险因素相关,如男性、存在意识或吞咽功能障碍、咳嗽反射减弱、隐性误吸、存在基础疾病、长期卧床、留置胃管等,而其预后影响因素主要有PSI评分、白细胞计数、C反应蛋白水平、血清白蛋白水平。

Objective To analyze the risk factors and prognostic factors of aspiration pneumonia in the elderly.Methods There were 50 elderly patients with aspiration pneumonia selected as the research group,and they were divided into improvement group(43 cases),and deterioration/death group(7 cases)according to different prognosis.Another 50 elderly patients with non-aspiration pneumonia were selected as the control group.The risk factors and prognostic factors of aspiration pneumonia in the elderly were analyzed.Results The age,acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)score on admission,and proportions of male,disturbance of consciousness,swallowing dysfunction,weakened cough reflex,hidden aspiration,long-term bed rest,indwelling gastric tube and history of gastroesophageal reflux,hypoproteinemia,periodontal disease,history of stroke,history of diabetes mellitus,history of coronary heart disease,hypertension history of the research group were higher than those of the control group,and the difference was statistically significant(P<0.05).The pneumonia severity index(PSI)score(103.73±7.82)points,white blood cells count(12.81±0.48)×10^(9)/L and C-reactive protein(56.19±9.81)mg/L of the improvement group were lower than(131.85±13.74)points,(15.71±1.05)×10^(9)/L and(82.38±8.62)mg/L of deterioration/death group,and serum albumin(26.19±3.86)g/L was higher than(22.38±2.18)g/L of deterioration/death group.All the difference was statistically significant(P<0.05).Conclusion Aspiration pneumonia in the elderly can be associated with a variety of risk factors,such as male,disturbance of consciousness,swallowing dysfunction,weakened cough reflex and hidden aspiration,underlying disease,long-term bed rest,indwelling gastric tube,and its prognostic factors mainly include PSI score,white blood cells counts,C-reactive protein and serum albumin level.