老年重症肺炎患者细胞炎性因子、凝血功能情况及预后的影响因素分析  

Analysis of cytoinflammatory factors,coagulation function and prognostic factors in elderly patients with severe pneumonia

作　　者：周瑜 代艳梅 王一平[2] 虎琼华[1] ZHOU Yu;DAI Yan-mei;WANG Yi-ping;HU Qiong-hua(ICU,Chengdu Second People?s Hospital,Chengdu,Sichuan 610000,China;Department of Neurosurgery,the Fifth Affiliated Hospital of Sun Yatsen University,Zhuhai,Guangdong 519000,China)

机构地区：[1]成都市第二人民医院ICU,四川成都610000 [2]中山大学附属第五医院神经外科,广东珠海519000

出　　处：《临床肺科杂志》2020年第1期70-73,共4页Journal of Clinical Pulmonary Medicine

摘　　要：目的了解老年重症肺炎患者细胞因子和凝血功能情况,并分析预后的相关影响因素。方法选择2015年4月-2018年4月期间我院收治的128例老年重症肺炎患者和130例老年普通肺炎患者作为研究对象。采用酶联免疫吸附法(ELISA)测定血清IL-6等炎性因子的含量,采用全自动血凝分析仪测定纤维蛋白原(Fib)等凝血功能指标水平并进行统计分析。结果观察组IL-6、IL-10表达高于对照组,TNF-α表达低于对照组,经t检验,差异有统计学意义,P<0.05。观察组患者的凝血指标PT、TT、APTT、Fib和D-二聚体水平均高于对照组,经t检验,差异均有统计学意义,P<0.05。经单、多因素logistic回归分析,FineⅤ级以上(OR=4.357,95%CI=2.182~9.692)、年龄(高)(OR=1.428,95%CI=1.107~1.923)、血红蛋白<90 g/L(OR=2.831,95%CI=1.411~4.886)、机械通气(OR=7.194,95%CI=3.028~12.173)和长期卧床(OR=3.021,95%CI=1.766~6.069)为影响老年重症肺炎预后的主要危险因素。结论老年重症肺炎患者炎症反应明显,存在明显凝血功能紊乱,高龄、机械通气、长期卧床、FineⅤ级以上、血红蛋白<90 g/L的老年重症肺炎患者预后较差。Objective To understand cytokines and coagulation function in elderly patients with severe pneumonia,and to analyze the prognostic factors.Methods 128 elderly patients with severe pneumonia and 130 elderly patients with common pneumonia admitted to our hospital from April 2015 to April 2018 were selected as the research objects.The content of serum IL-6 and other inflammatory factors was determined by ELISA.The levels of Fib and other coagulation function indexes were determined by automatic blood coagulation.Results The levels of IL-6 and IL-10 in the observation group were higher than those in the control group,and the level of TNF-αwas lower than that in the control group,and the differences were statistically significant by t test(P<0.05).The levels of PT,TT,APTT,Fib and D-dimer in the observation group were all higher than those in the control group,and the differences were statistically significant by t test(P<0.05).Through single and multiple factors logistic regression analysis,Fine V magnitude(OR=4.357,95%CI=2.1829.692),age(high)(OR=1.428,95%CI=1.1071.923),hemoglobin<90 g/L(OR=2.831,95%CI=1.411~4.886),mechanical ventilation(OR=7.194,95%CI=3.028~12.173)and long-term bed(OR=3.021,95%CI=1.766~6.069)were the main risk factors affecting the prognosis of elderly patients with severe pneumonia.Conclusion There is obvious inflammatory reaction and coagulation dysfunction in elderly patients with severe pneumonia.The elderly patients with severe pneumonia of old age,mechanical ventilation,long-term lie in bed,Fine V magnitude,or hemoglobin<90 g/L have poor prognosis.

关 键 词：重症肺炎 老年人 炎性因子 凝血功能 

分 类 号：R47[医药卫生—护理学]