老年肺炎患者急诊栓塞事件发生率及预测因子研究

A study on incidence of emergency embolic event and its predictive factors in elderly patients with pneumonia

目的 研究老年肺炎患者急诊栓塞事件发生率及预测因子。方法 回顾性选取2022年12月—2023年3月在上海市第六人民医院急诊科就诊并确诊为肺炎的年龄≥65岁的306例患者为研究对象,观察老年肺炎患者主要栓塞事件的发生情况,并采用Logistic回归分析法分析栓塞事件发生的独立预测因子。结果 168例发生肺动脉栓塞(55%);138例发生下肢深静脉血栓(45%);50例同时具有肺栓塞和深静脉栓塞(15%);16例缺血性脑卒中(5.2%);10例急性心肌梗死(3.4%);6例其他栓塞事件(0.2%)。年龄增加、凝血功能异常、既往栓塞史是老年肺炎患者急诊栓塞事件的独立预测因子;D-二聚体升高预测栓塞事件特异性差。结论 老年肺炎患者急诊栓塞事件的发生率可能极高,早期出现凝血功能异常,既往有过栓塞事件者及高龄患者应予以高度重视,及早规范抗凝治疗,以降低患者死亡率。

Objective To study the incidence of emergency embolic events and its predictive factors in elderly patients with pneumonia.Methods 306 patients aged≥65 years who were diagnosed with pneumonia in Department of Emergency Medicine,Sixth People s Hospital Affiliated to Shanghai Jiaotong University from December 2022 to March 2023 were retrospectively selected as the study subjects.The occurrence of their major embolic events was observed.Logistic regression analysis was used to analyze the independent predictive factors of embolic events.Results 168 cases(55%)developed pulmonary embolism;138 ones(45%)developed deep vein thrombosis in the lower limbs;50 ones(15%)had both pulmonary embolism and deep vein thrombosis;16 ones(5.2%)had ischemic stroke;10 ones(3.4%)had acute myocardial infarction;6 ones(0.2%)developed other embolic events.Increasing age,abnormal coagulation function and previous embolic history were independent predictive factors for emergency embolic events in elderly patients with pneumonia.D-dimer elevation had poor specificity in predicting embolic events.Conclusion The incidence of emergency embolic events in elderly patients with pneumonia may be very high.High attention should be paid to early onset of coagulation dysfunction,previous embolic events and senile patients,and anticoagulation therapy should be standardized as soon as possible to reduce the mortality of patients.