低磷血症与老年重症肺炎预后相关性研究

Correlation between hypophosphatemia and prognosis in elder with severe pneumonia

目的 重症肺炎是引起老年人死亡的主要病因之一,而低磷血症在老年患者中发病率高且常被忽视,探究二者相关性为老年重症肺炎合并低磷血症者提供临床诊疗依据;方法 采用回顾性研究方法,按照入组标准及排除标准收集自2021年2月—2022年9月诊断为“重症肺炎”老年患者,共88例,按照不同血磷水平分为低磷血症组及血磷正常组,在不同组间对患者基础状况、预后情况进行比较。结果 低磷血症与患者预后情况密切相关,低磷血症组既往存在脑血管疾病史者较多(45.9%vs.22.2%,χ^(2)=4.42,P=0.03),低磷血症及血磷正常组相比死亡率、休克患者比例及机械通气(有创机械通气及无创机械通气)比例无明显差异,低磷血症组有创机械通气比例明显升高(36.1%vs.14.8%,χ^(2)=4.06,P=0.04),且在存活患者中,低磷血症组有创机械通气时间比血磷正常组延长[(7.70±2.94)d vs.(3.33±0.57)d,t=2.47,P=0.03],存活患者中低磷血症组住院费用比血磷正常组更高(3.48万元vs. 5.17万元,Z=2.85,P<0.02)。在不同病原学之间血磷水平无明显差异性。结论 血磷水平和老年重症肺炎患者预后有相关性,严重低磷血症可引起患者有创机械通气比例及通气时间延长,并引起患者住院费用增多。

Objective Severe pneumonia is one of the major causes of death in elder,which the rate of rescue is only 50%.The incidence of hypophosphatemia which was often neglected can reach to 29%-34%or highter in intensive care unit.To explor the correlation between them,providing a more precise treatment for elder with severe pneumonia.Methods A retrospective study was conducted to collect 88 elder who diagnosed as"severe pneumonia"from February 2021 to September 2022.They were divided into different groups according to different blood phosphorus levels.Then explore the difference of prognosis between them.Results The group of hypophosphatemia which suffered cerebrovascular disease were more(45.9%vs.22.2%,χ^(2)=4.42,P=0.03).There was no significant difference between the hypophosphatemia group and the normal blood phosphorus group in mortality,the proportion of shock patients and mechanical ventilation(invasive mechanical ventilation and non-invasive mechanical ventilation).The proportion of invasive mechanical ventilation in the hypophosphatemia group was significantly higher(36.1%vs.14.8%,χ^(2)=4.06,P=0.04),and the time of invasive mechanical ventilation in hypophosphatemia group was longer[(7.70±2.94)d vs.(3.33±0.57)d,t=2.47,P=0.03].The cost in hypophosphatemia group was higher than that in normal blood phosphorus group(34.8 thousand Yuan vs.51.7 thousand Yuan,z=2.85,P<0.05).There was no significant difference in blood phosphorus levels among different pathogens,and hypophosphatemia was one of the important risk factors for patient death.Conclusion Hypophosphatemia is one of the risk factors of death.Severe hypophosphatemia can increase the proportion of invasive mechanical ventilation and prolong the time.