老年肺部感染合并多器官功能衰竭患者临床预后的影响因素分析  

Influencing factors of clinical prognosis in elderly patients with pulmonary infection and multiple organ failure

作　　者：张剑 万颖 黄图城[2] ZHANG Jian;WAN Ying;HUANG Tu-cheng(Department of Internal Medicine,the First Disabled Soldier Hospital of Guangdong Province,Guangzhou 510260,China;Department of Cardiovascular Medicine,Sun Yat-Sen Memorial Hospital,Sun Yat-Sen University,Guangzhou 510000,China)

机构地区：[1]广东省第一荣军医院内科,广州市510260 [2]中山大学孙逸仙纪念医院心血管内科,广东省广州市510000

出　　处：《广西医学》2020年第4期429-432,共4页Guangxi Medical Journal

摘　　要：目的探讨老年肺部感染合并多器官功能衰竭患者临床预后的影响因素。方法回顾性分析93例老年肺部感染合并多器官功能衰竭患者的临床资料,并根据患者入院治疗14 d后的死亡情况,将其分为生存组43例和病亡组50例。收集两组患者的性别、年龄、体质指数、基础疾病、衰竭器官数量、入院时生化指标、治疗方法及预后等情况,并分析影响老年肺部感染合并多器官功能衰竭患者临床预后的因素。结果单因素分析结果显示,生存组患者的年龄、基础疾病数量、衰竭器官数量、血细胞比容、体质指数、血浆白蛋白、血红蛋白水平、机械通气比例、抗生素早期联合使用比例、升压药使用比例、解痉平喘药使用比例与病亡组比较,差异均有统计学意义(均P<0.05)。多因素Logistic回归分析结果显示,年龄大、基础疾病数量多、衰竭器官数量多、血浆白蛋白低、血红蛋白水平低、机械通气是老年肺部感染合并多器官功能衰竭患者死亡的危险因素,而抗生素早期联合使用是其保护因素(均P<0.05)。结论对于高龄、存在多种基础疾病和多个器官衰竭的患者,早期联合使用抗生素、合理使用机械通气、加强营养支持等积极治疗可能是治疗老年肺部感染合并多器官功能衰竭患者的有效措施。Objective To explore the influencing factors of clinical prognosis in elderly patients with pulmonary infection and multiple organ failure.Methods The clinical data of 93 elderly patients with pulmonary infection and multiple organ failure were analyzed retrospectively.They were divided into survival group(43 cases)and death group(50 cases)according to the mortality of the patients 14 days after admission.Gender,age,body mass index,underlying diseases,number of failed organs,biochemical indicators on admission,therapeutic approaches,and prognosis were collected in the two groups,and the factors influencing clinical prognosis were analyzed in elderly patients with pulmonary infection and multiple organ failure.Results Univariate analysis results showed that there were statistically significant differences between the survival group and the death group in age,number of underlying diseases,number of failed organs,hematocrit,body mass index,plasma albumin,hemoglobin level,proportion of mechanical ventilation,proportion of early combination use of antibiotics,proportion of medications for raising blood pressure,proportion of medications for spasmolysis and relieving asthma(all P<0.05).Multivariate Logistic regression analysis results indicated that older age,more underlying diseases,more failed organs,lower plasma albumin,lower hemoglobin level,and mechanical ventilation were the risk factors for death in elderly patients with pulmonary infection and multiple organ failure,while the early combination use of antibiotics made the protective factors(all P<0.05).Conclusion For elderly patients with multiple underlying diseases and multiple organ failure,active therapies such as early combined use of antibiotics,rational use of mechanical ventilation,and intensity nutritional support might be the effective measures for treating elderly patients with pulmonary infection and multiple organ failure.

关 键 词：肺部感染 多器官功能衰竭 老年人 预后 影响因素 

分 类 号：R563.1[医药卫生—呼吸系统]