急诊就诊晚期肺癌患者的临床特征及死亡影响因素分析

Clinical features of advanced lung cancer patients visited emergency department and risk factors of their death within 3 months

目的分析急诊就诊的晚期肺癌患者临床特点及3个月内死亡的危险因素。方法分析2016年1月-2018年12月解放军总医院第一医学中心肿瘤内科正规治疗过程中急诊入院的112例晚期肺癌患者临床特征,并分析其死亡危险因素。结果 112例中,男75例(66.9%),女37例(33.1%),中位年龄67.2岁。病理类型包括腺癌67例(59.8%),鳞癌24例(21.4%),小细胞肺癌21例(18.8%)。就诊原因为肺部感染69例(61.6%),呼吸衰竭63例(56.3%),意识障碍26例(23.2%),咯血13例(11.3%),癫痫8例(7.1%),出血6例(5.4%),放射性肺炎6例(5.4%),上腔静脉综合征4例(3.6%)。3个月内死亡率为64.3%。单因素分析显示,呼吸衰竭、白细胞计数、血乳酸、白细胞介素6、D-二聚体、白蛋白与晚期肺癌患者急诊入院后3个月内死亡相关(P均<0.05)。多因素logistic回归分析显示,乳酸(OR:1.624,P=0.024)、白蛋白(OR:0.839,P=0.001)和呼吸衰竭(OR:2.972,P=0.013)是晚期肺癌急诊后3个月内死亡独立影响因素(P均<0.05)。结论晚期肺癌急诊入院患者预后差,3个月内死亡率高,高乳酸血症、低白蛋白血症和呼吸衰竭是其3个月内死亡独立危险因素。

Objective To analyze clinical features of advanced lung cancer patients admitted to emergency department and risk factors of death within 3 months.Methods Clinical characteristics of 112 patients with advanced lung cancer admitted to the emergency department during the regular treatment from January 2016 to December 2018 were analyzed,and the risk factors of death were analyzed by univariate and multivariate regression.Results Of the 112 patients,75(66.9%)cases were male and 37(33.1%)cases were female,with a median age of 67.2 years.There were 67 cases of adenocarcinoma(59.8%),24 cases of squamous cell carcinoma(21.4%)and 21 cases of small cell lung cancer(18.8%).Pneumonia occurred in 69 cases(61.6%),dyspnea in 63 cases(56.3%),respiratory failure in 63 cases(56.3%),consciousness disturbance in 26 cases(23.2%),hemoptysis in 13 cases(11.3%),epilepsy in 8 cases(7.1%),hemorrhage in 6 cases(5.4%),radioactive pneumonia in 6 cases(5.4%),and superior vena cava syndrome in 4 cases(3.6%).The mortality rate was 64.3%within 3 months.Univariate analysis showed that respiratory failure,white blood cell count,blood lactic acid,interleukin-6,D-dimer,and albumin were associated with the mortality within 3 months after emergency admission in patients with advanced lung cancer(P<0.05).Multivariate logistic regression analysis showed that blood lactic acid(OR,1.624;P=0.024),albumin(OR,0.839;P=0.001)and respiratory failure(OR,2.972;P=0.013)were independent factors for death within 3 months after emergency admission(P<0.05).Conclusion Patients with advanced lung cancer admitted to the emergency department have a poor prognosis and a high mortality rate within 3 months.Hyperlactic acidemia,hypoproteinemia and respiratory failure are independent risk factors for death within 3 months.