老年脓毒症合并心力衰竭患者临床特点和危险因素分析  

Clinical characteristics of elderly patients with sepsis combined with heart failure and the risk factors analysis

作　　者：史红伟[1] 宋希[1] 田海红 任丽杰 韩泽红[1] Shi Hongwei;Song Xi;Tian Haihong;Ren Lijie;Han Zehong(Department of Emergency Medicine, Heji Hospital Affiliated to Shanxi Changzhi Medical College, Changzhi 046011, China;Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China)

机构地区：[1]山西省长治医学院附属和济医院急诊科,046011 [2]首都医科大学附属北京朝阳医院急诊科,100020

出　　处：《中华老年医学杂志》2019年第6期609-612,共4页Chinese Journal of Geriatrics

摘　　要：目的探讨老年脓毒症合并心力衰竭患者的临床特点和短期病死率的危险因素。方法本研究为回顾性分析。选择我院2013年1月至2018年1月收治的老年脓毒症合并心力衰竭患者的临床资料,按照住院期间的生存情况分为存活组(134例)和死亡组(83例)。比较两组患者临床特点,分析影响病死率的危险因素。结果217例老年患者入选本研究。其中,男性113例,平均年龄为(72.3±7.5)岁。脓毒症病死率为38.3%,其中29例死亡原因为脓毒症相关死亡,54例为非脓毒症相关死亡。两组患者多为肺部感染(171例,78.8%)和皮肤软组织感染(28例,12.9%)。两组患者的年龄、体质指数、吸烟、2型糖尿病、慢性阻塞性肺病、平均动脉压、动脉氧分压、C反应蛋白、白细胞计数、中性粒细胞和淋巴细胞计数、肾小球滤过率、血钠水平、白蛋白、血乳酸和左心室射血分数等差异均有统计学意义(均P<0.05)。同时,死亡组的有创机械通气率(χ^2=13.209,P<0.001)和持续性肾脏替代率(χ^2=7.402,P=0.007)均高于存活组。多因素COX回归分析结果显示,年龄、慢性阻塞性肺病、白蛋白和肾小球滤过率是影响病死率的危险因素(均P<0.05)。结论老年脓毒症合并心力衰竭患者多为肺部感染和皮肤软组织感染,感染重,心肾功能差。高龄、慢性阻塞性肺病、低白蛋白和低肾小球滤过率是影响病死率的危险因素。Objective To investigate clinical characteristics of elderly patients with sepsis combined with congestive heart failure and risk factors for short-term mortality. Methods Clinical data of elderly patients with sepsis combined with congestive heart failure who were admitted in our hospital from January 2013 to January 2018 were selected and retrospectively analyzed.They were divided into the survival group(n=134)and the death group(n=83)according to survival status during hospitalization.The clinical characteristics and risk factors for mortality were analyzed and compared. Results A total of 217 elderly patients were enrolled, with 113 males and a mean age of(72.3±7.5)years.The death rate of sepsis was 38.3%(83/217 cases), and 29 cases died of sepsis and 54 cases died of other diseases.Pneumonia accounted for 78.8%(171/217 patients)in all patients of two groups, and skin and soft tissue infection for 12.9%(28/217 cases). There were significant differences between two groups in age, body mass index, smoking, diabetes, chronic obstructive pulmonary disease, mean arterial pressure, arterial oxygen partial pressure(PaO2), C-reactive protein, white blood cell counts, neutrophil and lymphocyte counts, glomerular filtration rate, serum sodium level, albumin level, lactate level, and left ventricular ejection fraction(P<0.05). Furthermore, the rates of invasive mechanical ventilation and continuous renal replacement therapy were higher in the death group than in the survival group(χ^2=13.209 and 7.402, P<0.001 and 0.007). Multivariate Cox regression analysis showed that advanced age, chronic obstructive pulmonary disease, low albumin level and low glomerular filtration rate were risk factors for mortality(P<0.05). Conclusions Elderly patients with sepsis combined with congestive heart failure often have severe pneumonia and violent skin and soft tissue infection, with worse heart and renal function.Advanced age, chronic obstructive pulmonary disease, low albumin level and low glomerular filtration rate are risk factor

关 键 词：脓毒症 心力衰竭 危险因素 

分 类 号：R459.7[医药卫生—急诊医学] R541.6[医药卫生—治疗学]