急诊老年社区获得性肺炎患者预后相关危险因素分析  

Analysis of prognostic risk factors in emergency elderly patients with community acquired pneumonia

作　　者：李建国[1] 周明 徐永明 郭伟[1] 姬文卿 刘妍[3] LI Jianguo;ZHOU Ming;XU Yongming;GUO Wei;JI Wenqing;LIU Yan(Department of Emergency,Beijing Tiantan Hospital,Capital Medical University,Beijing,100070,China;Department of Emergency,Beijing Chaoyang Hospital,Capital Medical University;Department of Emergency,Beijing Jishuitan Hospital)

机构地区：[1]首都医科大学附属北京天坛医院急诊科,北京100070 [2]首都医科大学附属北京朝阳医院急诊科 [3]北京积水潭医院急诊科

出　　处：《临床急诊杂志》2020年第6期446-450,共5页Journal of Clinical Emergency

摘　　要：目的:探讨急诊科老年社区获得性肺炎患者的临床特点,分析患者预后相关危险因素。方法:收集并回顾性分析3家三甲医院2018-09—2019-05期间入住急诊科的185例社区获得性肺炎患者的临床资料,将其分为预后良好组(138例)和预后不良组(47例),比较2组患者的一般资料、临床特点、CURB-65评分、PSI评分、实验室检查结果、治疗策略等,采用SPSS 20.0统计软件分析,采用单因素分析、多因素Logistic回归分析影响患者预后的危险因素,以P<0.05为差异有统计学意义。结果:单因素分析结果显示,预后不良组CURB-65分数≥3分、PSI分数≥130分、外周血WBC异常比例高于预后良好组,预后良好组初始经验性抗感染治疗联合使用抗感染药物比例多于预后不良组,预后良好组PSI平均值低于预后不良组,均差异有统计学意义(P<0.05);结合既往文献结果,将基础疾病多、降钙素原、乳酸也列入多因素Logistic回归分析,结果显示WBC异常、PSI评分≥130分、降钙素原水平是影响患者预后的独立危险因素(P<0.05)。结论:老年社区获得性肺炎患者WBC异常、PSI评分高、降钙素原水平高等问题是预后不良的独立危险因素,应给予高度关注,以改善患者的预后。Objective:To investigate the clinical characteristics of emergency community-acquired pneumonia in the elderly and analyze the prognostic risk factors.Method:Collected and analyzed retrospectively three hospitals between September 2018 and May 2019 in the emergency department patients with community-acquired pneumonia clinical data.It was divided into good prognosis group and poor prognosis group,compared two groups of patients with general information,clinical characteristics,CURB-65 score,PSI,laboratory results and treatment strategy,adopts SPSS 20.0 statistical analysis software,using single factor analysis and logistic regression analysis of multiple factors affect the prognosis of patients with risk factors,P<0.05 for the difference was statistically;Result:Of the 185 cases of patients,138 cases belong to good prognosis group,47 cases belong to poor prognosis group.The results of single factor analysis showed that the case proportion of CURB-65 score≥3,the PSI≥130 and abnormal white blood cell count in the group with poor prognosis were higher than those in the group with good prognosis,the proportion of patients in the good prognosis group who received initial empirical anti infective therapy combined with anti infective drugs was higher than that in the poor prognosis group,and the average value of PSI in the group with good prognosis were lower than that in the group with poor prognosis,with statistically significant differences(P<0.05).Based on the results of previous literature,multiple basic diseases,procalcitonin and lactate were also included in logistic regression analysis.The results of multivariate logistic regression analysis showed that abnormal white blood cell count,PSI≥130 points,and procalcitonin level were independent risk factors affecting the prognosis of patients(P<0.05).Conclusion:Abnormal white blood cell count,high PSI score and high level of procalcitonin in elderly patients with community acquired pneumonia are independent risk factors for poor prognosis.

关 键 词：社区获得性肺炎 急诊 老年 预后 危险因素 

分 类 号：R563.1[医药卫生—呼吸系统]