老年重症社区获得性肺炎临床特征及预后影响因素分析  

Clinical features and prognostic factors of elderly patients with severe community-acquired pneumonia

作　　者：陈亮[1] 李真[1] 

机构地区：[1]北京积水潭医院感染疾病科,100035

出　　处：《国际流行病学传染病学杂志》2015年第6期380-383,共4页International Journal of Epidemiology and Infectious Disease

摘　　要：目的了解老年重症社区获得性肺炎（SCAP）的I临床特征，并对影响其预后的因素进行探讨。方法回顾性对比分析北京积水潭医院2008-2014年收治的46例老年和22例非老年SCAP住院患者，分析老年SCAP的临床特征；采用Logistic多因素回归分析对比老年SCAP死亡与存活患者的人口学、临床及治疗等因素的差异。结果老年SCAP患者多合并有慢性基础病，且呼吸频率普遍较快（≥30次／min），低血压、意识改变表现较多见，实验室检查血尿素氮／肌酐常升高，住院天数和死亡率也明显高于非老年SCAP患者（P均〈0．05）。单因素分析发现在46例老年SCAP患者中，死亡组在1年内曾有社区获得性肺炎病史、体温〈36℃、结构性肺病、感染性休克方面高于存活组（P〈0．05或P〈0．01）；死亡组采用降阶梯治疗、初始联合治疗以及B．内酰胺联合大环内酯治疗方案者的比例低于存活组（P〈0．01）。多因素Logistic回归分析发现，感染性休克（OR=36．173，95％CI：4．190—312．277）和初始联合治疗（OR=0．017，95％C1：0．0021～0．225）是影响SCAP预后的独立危险因素。结论老年SCAP与非老年SCAP临床特征有所差异。感染性休克可作为老年SCAP预后不良的评价指标之一：采用初始联合治疗有助于降低老年SCAP患者的病死率。Objective To investigate clinical features and prognostic factors of the elderly patients with severe community-acquired pneumonia （SCAP）. Methods We retrospectively analyzed 46 elderly and 22 non-elderly inpatients with SCAP from 2008 to 2014 in Jishuitan Hospital. Then we studied clinical features of elderly patients with SCAP, and compared the differences on factors such as demography, clinic, treatment, etc. by using logistic regression analysis. Results Compared with non-elderly group, the elderly SCAP group usually had basic chronic diseases, faster respiratory rate （≥30 times/min）, low blood pressure, consciousness change, higher blood urea nitrogen and creatinine, longer hospital day and higher mortality rate （P all 〈0.05）. Among the 46 elderly patients with SCAP, univariate analysis showed that the death group who had the incidence of CAP disease history within last one year, body temperature〈36 ℃ and structural lung disease, septic shock were higher than survival group （P〈0.05 or P〈 0.01 ）; while for those who had had antimicrobial therapy, de-escalation antibiotic therapy and 13-1actam antibiotics plus macrolide, the death group was lower than the survival group （P〈O.01）. Logistic regressesion analysis showed that septic shock （OR=36.173, 95%CI：4.190-312.277）and combined antimicrobial therapy （OR=0.017, 95%CI： 0.0021- 0.225） were independent prognostic factors. Conclusions The clinical features are different between elderly SCAP and no-elrderly SCAP patients. Septic shock is one of the SCAP prognostic risk factors, and initially combine antimicrobial therapy is one of protective factor helping reduce the mortality.

关 键 词：肺炎 临床特征 预后因素 老年 

分 类 号：R563.1[医药卫生—呼吸系统]