综合分析肺部感染诱发老年多器官功能不全综合征的临床特点  

Comprehensive analysis of multiple organ dysfunction syndrome induced by pulmonary infection in elderly patients

作　　者：李微[1] 殷少军[1] 陆卫东[1] 林桦[1] 张毅琴[1] 樊美红[1] 祝炜[1] 陈维杰[1] 董福轮[1] 

机构地区：[1]同济大学附属第十人民医院老年科,上海市200072

出　　处：《实用老年医学》2012年第6期453-455,共3页Practical Geriatrics

基　　金：上海市干部保健局科研基金资助项目(2011GB24);上海市卫生局科研基金项目(2010082)

摘　　要：目的综合分析肺部感染诱发老年多器官功能不全综合征(multiple organ dysfunction syndrome in the elderly,MODSE)的临床特点。方法回顾性综合分析我院老年科64例因肺部感染诱发MODSE患者的临床特点、影像和实验室资料、APACHEⅡ评分变化等情况。结果 64例因肺部感染诱发MODSE患者均存在≥3种基础疾病,以脑血管疾病最多,占70.3%(45/64)。全部肺部感染病原体以耐药铜绿假单胞菌54.7%(35/64)、金黄色葡萄球菌28.1%(18/64)为多见。好转41例(64.1%),死亡23例(35.9%),其中2个器官功能衰竭者死亡3例(13.1%,2/23),3个器官功能衰竭者死亡18例(72.3%,18/23),≥4个以上器官功能衰竭者2例全部死亡。存活患者APACHEⅡ评分明显低于死亡患者。结论肺部感染是诱发MODSE主要诱因之一,基础疾病、受累器官越多,APACHEⅡ评分高,抗菌药物初始治疗不合理者,病死率越高。早期、合理使用抗菌药物治疗,对肺部感染诱发的MODSE具有重要临床价值。Objective To comprehensively analyze the clinical characteristics of multiple organ dysfunction syndrome in the elderly（MODSE） induced by pulmonary infection. Methods Clinical data,image and laboratory data and the changes of APACHE Ⅱscores of MODSE induced by pulmonary infection in 64 patients who were hospitalized in Department of Geriatrics were analyzed retrospectively. Results Each of the 64 patients with pulmonary infection-induced MODSE had more than or equal to 3 underlying diseases, with cerebrovascular disease accounting for 70.3% （45/64）. Of all pulmonary infection pathogens, 54.7% （35/64） was pseudomonas aeruginosa, 28.1% （18/64） being staphylococcus aureus. Of all the cases 41 （64.1%） improved, 23 died （35.9%）,among them 3 died of 2-organ failure（13.1%,2/23）, 18 died of 3-organ failure （72.3%,18/23）, and 2 died of ≥4-organ failure.The APACHE Ⅱ score of survival patients was obviously lower than that in dead patients. Conclusions Pulmonary infection is the main cause of MODSE.The fatality rate of MODSE is related to the number of failure organs, the number of underlying diseases,the high scores of APACHEⅡ and inadequate treatment of antimicrobial agents. Early and rational use of empirical antimicrobial therapy has important clinical value for pulmonary infection-induced MODSE patients.

关 键 词：老年人 肺部感染 多器官功能不全综合征 抗菌药物 

分 类 号：R563.1[医药卫生—呼吸系统]