医养结合型养老机构老年人吸入性肺炎患者预后及影响因素logistic回归分析

Prognosis of middle-aged and elderly patients with aspiration pneumonia in integrated medical and elderly care institutions and logistic regression analysis of related influencing factors

目的探讨医养结合型养老机构老年人吸入性肺炎患者预后及相关影响因素。方法选取2016年1月至2020年12月医养结合型养老机构中604例老年人吸入性肺炎患者,统计患者预后情况,并对预后影响因素进行单因素与多因素logistic回归方程分析,采用受试者工作特征曲线(Receiver operating characteristic,ROC)及曲线下面积(Area under the curre,AUC)分析logistic回归模型对老年人吸入性肺炎预后的预测价值。结果单因素分析显示,阿尔茨海默病、重症肺炎、日常生活能力、抢救次数与老年人吸入性肺炎患者预后有关(P<0.05);logistic回归模型显示,有阿尔茨海默病患者死亡风险可能是无阿尔茨海默病的2.883倍,重症肺炎患者死亡风险可能是非重症肺炎者的3.292倍,日常生活能力重度依赖患者死亡风险可能是轻度依赖者的3.719倍,日常生活能力中度依赖患者死亡风险可能是轻度依赖患者的2.558倍,抢救次数≥2次患者死亡风险可能是0次的2.922倍(P<0.05),logistic回归方程:logistic(P)=-8.264+2.883×阿尔茨海默病≥60岁+3.292×重症肺炎+3.719×日常生活能力重度依赖+2.558×日常生活能力中度依赖+2.922×抢救次数,预测老年人吸入性肺炎预后AUC为0.907(95%CI:0.848~0.966),当logistic(P)>12.97时预测价值最优,预测敏感度为83.87%,特异度为84.15%。结论阿尔茨海默病、重症肺炎、日常生活能力中重度依赖、抢救次数≥2次与医养结合型养老机构老年人吸入性肺炎患者预后有关,可作为预测预后的一个方案,为临床治疗、护理管理等提供参考,同时加强对伴有以上特征患者的干预有助于促进预后的改善。

Objective To investigate the prognosis of middle-aged and elderly patients with aspiration pneumonia and related influencing factors in integrated medical and elderly care institutions.Methods A total of 604 elderly patients with aspiration pneumonia were selected from integrated medical and elderly care institutions from January 2016 to December 2020.The prognosis of the patients was counted,and the prognostic factors were analyzed by univariate and multivariate logistic regression equations.The receiver operating characteristic(Receiver operating characteristic,ROC)curve and area under the curve(Area under the curre,AUC)were used to analyze the predictive value of logistic regression model for the prognosis of elderly patients with aspiration pneumonia.Results Univariate analysis showed that Alzheimer′s disease,severe pneumonia,ability of daily living(ADL),and the number of rescues were related to the prognosis of elderly patients with aspiration pneumonia(P<0.05).Logistic regression model showed that the death risk of patients with Alzheimer′s disease was 2.883 times higher than that of patients without Alzheimer′s disease,the death risk of patients with severe pneumonia was 3.292 times higher than that of patients without severe pneumonia,the death risk of patients with severe dependence in ADL was 3.719 times higher than that of patients with mild dependence,the death risk of patients with moderate dependence in ADL was 2.558 times higher than that of patients with mild dependence,and the death risk of patients with rescue times≥2 times was 2.922 times higher than that of patients without rescue times(P<0.05).Logistic regression equation:logistic(P=-8.264+2.883)×Alzheimer disease≥60 years old+3.292×severe pneumonia+3.719×severe dependence in ADL+2.558×moderate dependence in ADL+2.922×number of rescues.The predicted prognosis AUC of elderly aspiration pneumonia was 0.907(95%CI:0.848-0.966).When logistic(P>12.97),the predictive value was the best,with the predictive sensitivity being 83.87%,and the specificity being 84.15%.Conclusion Alzheimer′s disease,severe pneumonia,moderate and severe dependence in the ability of daily living and rescue times≥2 are related to the prognosis of middle-aged and elderly patients with aspiration pneumonia in the integrated medical and elderly care institutions,which can be used as a prognostic plan for clinical treatment and nursing management.At the same time strengthening the intervention of patients with the above characteristics will help to promote the improvement of prognosis.