重症监护病房重症肺炎病人贫血的发生发展及对预后的影响

Incidence,progression of anemia and impact on prognosis in patients with severe pneumonia in intensive care unit

目的分析重症肺炎病人在ICU住院期间贫血的发生发展及对临床结局的影响。方法选择2020年3月1日至2022年3月31日南京市第一医院ICU收治的首要诊断为重症肺炎的老年病人,通过医疗电子信息系统收集病人临床资料,根据临床结局将病人分为生存组与死亡组,比较2组病人基线特征、ICU住院期间Hb变化;采用二分类Logistic回归分析影响病人预后的危险因素。结果共43例病人纳入研究,其中死亡22例,生存21例。与生存组相比,死亡组病人年龄更大,入ICU时序贯器官衰竭评分(SOFA)和APACHEⅡ评分更高,住院期间平均Hb水平更低。ICU住院期间,2组病人Hb持续下降,平均下降总量达(24.70±23.39)g/L,且第7天起,死亡组Hb较生存组明显下降。年龄、是否合并基础疾病、住院期间Hb平均水平与病人死亡风险相关(OR分别为1.199、0.005、0.815)。结论贫血与ICU重症肺炎病人不良预后有关,应积极预防与纠正。

Objective To investigate the onset and progression,and the impact of anemia on the prognosis of the patients with severe pneumonia admitted to intensive care unit(ICU).Methods A retrospective case-control study was conducted involving the patients with severe pneumonia who were admitted to ICU of Nanjng First Hospital from March 1,2020 to March 31,2022.The patients were divided into survival group and death group according to their clinical outcome.The clinical data were collected from electronic medical record system.The baseline data and the level of hemoglobin(Hb)during ICU hospitalization were compared between the two groups.Logistic regression analysis was used to analyze the risk factors affecting the prognosis of the patients.Results A total of 43 patients were enrolled in the study,of which 22 died and 21 survived.Compared with survival group,death group had older age,higher score of Sequential Organ Failure Assessment(SOFA)and Acute Physiology and Chronic Health Evaluation scoring system(APACHEⅡ),lower average level of Hb over ICU days.During the ICU stay,the level of Hb kept dropping.The average total decrease of Hb reached(24.70±23.39)g/L.Logistic regression analysis showed that age,comorbidity and the average level of Hb were associated with the risk of worse outcome of the patients with severe pneumonia.Conclusions Anemia has negative effect on the prognosis of the patients with severe pneumonia in ICU,and it is important to prevent and treat hospital-acquired anemia.