老年重症肺炎患者并发急性胃肠功能损伤的危险因素分析

Risk factors analysis of acute gastrointestinal injury in patients with elderly severe pneumonia

目的分析重症医学科(ICU)内老年重症肺炎(SP)患者并发急性胃肠功能损伤(AGI)的临床特点,并探讨发生AGI的相关危险因素。方法回顾性收集2020年1月至2022年12月中国人民解放军联勤保障部队第九○一医院ICU收治的老年SP患者临床资料,根据是否发生AGI分为AGI组和非AGI组。比较2组患者基线资料以及实验室检查指标,采用单因素分析筛选出差异有统计学意义的变量,进行多因素logistic回归分析并构建风险预测模型。绘制受试者工作特征(ROC)曲线评价各预测指标对老年SP患者发生AGI的预测效能。结果共纳入71例老年SP患者,其中AGI患者46例、非AGI患者25例,AGI发生率64.8%。2组急性生理和慢性健康评分系统(APACHEⅡ)评分、序贯器官衰竭评分、C反应蛋白(CRP)、乳酸、血管活性药物使用比例比较,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,APACHEⅡ评分、CRP和乳酸是老年SP患者并发AGI的独立危险因素(P<0.05)。APACHEⅡ评分,CRP和乳酸以及三者联合建立的风险预测模型,其ROC曲线下面积分别是0.758、0.748、0.811和0.883。结论老年SP并发AGI的独立危险因素为APACHEⅡ评分、CRP和乳酸,据此建立的预测模型较单指标预测具有更高的价值。

Objective To analyze the clinical characteristics and risk factors for elderly patients with severe pneumonia(SP)complicated by acute gastrointestinal injury(AGI)in the intensive care unit(ICU).Methods From January 2020 to December 2022,Seventy-one elderly patients with SP admitted to the Department of Critical Care Medicine,901 Hospital of the Joint Logistic Support Force of Chinese People′s Liberation Army were enrolled.They were divided into AGI group and non-AGI group according to whether AGI occurred.Baseline data and laboratory test results of the two groups were compared,factors with statistically significant differences were screened for multivariate Logistic regression analysis and a prediction model was constructed.The receiver operating characteristic curves of subjects in the two groups were drawn to evaluate the predictive ability of each predictor.Results Among 71 elderly patients with severe pneumonia,including 46 patients with AGI and 25 patients without AGI,with an AGI incidence rate of 64.8%.Acute Physiology and Chronic Health Evaluation(APACHE)Ⅱscore,Sequential Organ Failure Assessment(SOFA)score,C reactive protein(CRP),lactic acid and use of vasoactive drugs were statistically significant between two groups.Multivariate logistic regression analysis showed that APACHEⅡscore,CRP and lactic acid were independent risk factors for AGI in elderly SP patients.According to the above risk factors,a prediction model was established,and the AUC of three risk factors and the combined prediction model were 0.758,0.748,0.811 and 0.883 respectively.Conclusions The independent risk factors of AGI in elderly patients with SP are APACHEⅡscore,CRP and lactic acid.The prediction model established based on these factors had good prediction efficiency.