老年脓毒症合并心力衰竭患者的临床特点及影响因素分析  

Clinical characteristics and influential factors in older adult patients with sepsis and heart failure

作　　者：吴芬[1] 杨杰[1] 刘赟[1] 赵荣美[1] 范良梅 夏余群[1] Wu Fen;Yang Jie;Liu Yun;Zhao Rongmei;Fan Liangmei;Xia Yuqun(Department of Infectious Disease,Lishui Central Hospital,Lishui 323000,Zhejiang Province,China)

机构地区：[1]丽水市中心医院感染科,丽水323000

出　　处：《中国基层医药》2024年第9期1358-1362,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省医药卫生科技计划(2020ZH013)。

摘　　要：目的探讨老年脓毒症合并心力衰竭患者临床特点,分析其预后影响因素。方法回顾性选取2020年1月至2022年12月丽水市中心医院收治的老年脓毒症并心力衰竭患者88例纳入心力衰竭组,另按照1∶1的比例选择88例老年脓毒症未合并心力衰竭患者纳入非心力衰竭组,并根据心力衰竭组患者住院期间生存情况,将其分为生存组与死亡组两个亚组,通过logistic回归分析老年脓毒症患者心力衰竭发生及疾病不良预后的危险因素。结果心力衰竭组与非心力衰竭组性别、吸烟史、饮酒史、高血压病史、糖尿病病史比较差异均无统计学意义(均P>0.05)。心力衰竭组年龄≥75岁比例[52.27%(46/88)]、呼吸系统感染比例[53.41%(47/88)]均高于非心力衰竭组的34.09%(30/88)、29.55%(26/88),差异均有统计学意义(χ ^(2)=5.93、10.37,均P<0.05)。logistic分析显示高龄、呼吸系统感染是脓毒症患者心力衰竭发生的独立危险因素;脓毒症合并心力衰竭患者住院期间生存45例,死亡43例,病死率为48.86%;死亡组年龄[(76.27±4.14)岁]大于生存组[(72.29±4.06)岁],死亡组脑钠肽(BNP)水平为(636.70±70.29)pg/mL、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)评分为(31.93±3.08)分,均高于生存组的(552.80±54.66)pg/mL、(27.06±3.80)分;死亡组乳酸清除率[(13.63±4.84)%]、血清白蛋白水平[(26.09±4.77)g/L]均低于生存组的(19.94±5.07)%、(30.55±5.17)g/L,差异均有统计学意义(t=4.55、6.27、6.59、5.97、4.20,均P<0.05);logistic分析显示,脓毒症合并心力衰竭患者高龄、血清BNP高表达、高APACHEⅡ评分是其预后不良死的危险因素,24 h乳酸清除率高、白蛋白高表达是患者预后生存的保护因素。结论高龄、呼吸系统感染脓毒症患者发生心力衰竭风险较高,且高龄、BNP高表达、APACHEⅡ评分增加均可增加患者死亡风险,高乳酸清除率和白蛋白高表达则可降低患者死亡风险。Objective To investigate the clinical characteristics in older adult patients with sepsis and heart failure,and to analyze the influential factors of prognosis.Methods Eighty-eight older adult patients with sepsis and heart failure who received treatment at Lishui Central Hospital from January 2020 to December 2022 were retrospectively included in the heart failure group.Eighty-eight older adult patients with sepsis,who did not have heart failure,were selected in a 1:1 ratio to form a non-heart failure group.Based on their survival status during hospitalization,the patients in the heart failure group were divided into two subgroups:the survival group and the death group.Logistic regression analysis was performed to identify the risk factors associated with the development of heart failure and adverse disease outcomes in older adult patients with sepsis.Results There were no statistically significant differences in sex,smoking history,alcohol consumption history,history of hypertension,and history of diabetes between the heart failure group and the non-heart failure group(all P>0.05).However,the proportion of patients aged 75 years or older in the heart failure group was 52.27%(46/88),which was significantly higher than the proportion in the non-heart failure group[34.09%(30/88),χ ^(2)=5.93,P<0.05].The proportion of patients with respiratory system infections in the heart failure group was 53.41%(47/88),which was significantly higher than the proportion in the non-heart failure group[29.55%(26/88),χ ^(2)=10.37,P<0.05].Logistic regression analysis showed that advanced age and respiratory system infections are independent risk factors for the development of heart failure in patients with sepsis.Among patients with sepsis and heart failure,45 survived and 43 died,resulting in a mortality rate of 48.86%.The average age of patients in the death group was(76.27±4.14)years,which was significantly higher than that in the survival group[(72.29±4.06)years,t=4.55,P<0.05].The brain natriuretic peptide level and the Acute

关 键 词：脓毒症 心力衰竭 预后 死亡率 危险因素 急性病生理学和长期健康评价 血清白蛋白 乳酸 

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