急诊科老年肺部感染患者出院时生活质量研究  

Quality of life at discharge in elderly patients with pulmonary infection in emer-gency department

作　　者：赵红俊 孙海洋 张丽 黄夕华 Zhao Hongjun;Sun Haiyang;Zhang Li;Huang Xihua(Department of Emergency,First Affiliated Hospital with Nanjing Medical University,Jiangsu Provincial Hospital,Nanjing 210000,China)

机构地区：[1]南京医科大学第一附属医院·江苏省人民医院急诊科,南京210000

出　　处：《中华老年多器官疾病杂志》2025年第4期241-245,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：国家自然科学基金(81770086);江苏省自然科学基金青年基金(BK20201078)。

摘　　要：目的研究急诊老年肺部感染患者出院时的生活质量。方法将南京医科大学第一附属医院急诊病房2022年1月至2023年1月收治的310例老年社区获得性肺炎(CAP)患者作为研究对象,统计患者住院期间病死率,并在存活者出院时采用健康调查简表(SF-36)调查其生活质量,计算其SF-36量表总得分。根据患者SF-36量表得分,将其分为高水平组(SF-36量表得分≥总得分,n=126)与低水平组(SF-36量表得分<总得分,n=134)。在患者出院后进行为期1年的随访,统计患者因CAP再次入院率及病死率。采用SPSS 22.0软件进行数据分析。根据数据类型,组间比较分别采用t检验、χ^(2)检验及(或)Fisher精确概率法。采用二元logistic回归模型分析影响老年CAP急诊存活者出院时生活质量的相关因素。结果310例急诊老年CAP患者住院期间死亡者共43例(13.87%),出院时存活者共267例(86.13%),267例存活者出院时均填写SF-36生活质量调查量表,共回收有效调查问卷260份(97.39%)。纳入患者SF-36量表总得分为(573.63±65.69)分。急诊老年CAP存活者出院时SF-36量表各维度得分以及总得分均低于国内常模,差异均有统计学意义(P<0.05)。以急诊老年CAP存活者出院时生活质量作为因变量,行二元logistic回归分析发现,住院时间≥14 d(OR=2.201,95%CI 1.373~3.530)、基础性疾病种类>2种(OR=3.916,95%CI 1.736~8.832)、CRP>42.03 mg/L(OR=1.889,95%CI 1.027~3.475)、低蛋白血症(OR=2.326,95%CI 1.142~4.737)、肺炎严重指数分级4~5级(OR=2.210,95%CI 1.279~3.818)、入院时日常生活能力量表评分<90分(OR=1.925,95%CI 1.196~3.100)是患者出院时生活质量的危险因素(P<0.05),接种流感和(或)肺炎链球菌疫苗(OR=0.259,95%CI 0.116~0.580)是其保护因素(P<0.05)。出院时生活质量低水平组患者随访1年时间内因CAP再次入院率及死亡率均高于高水平组,差异均有统计学意义(P<0.05)。结论急诊老年CAP存活者出院时生活质量明显低�Objective To study the quality of life(QoL)at discharge in elderly patients with pulmonary infection in emergency department.Methods A total of 310 elderly patients with community-acquired pneumonia(CAP)admitted in emergency ward of our hospital from January 2022 to January 2023 were recruited in this study.The mortality of the patients during hospitalization was counted,and the QoL of survivors was investigated by 36-item short-form health survey(SF-36)at discharge.According to the SF-36 scale score,the elderly emergency CAP survivors were divided into high-level group(the score≥the average score,n=126)and low-level group(the score<the average score,n=134).All these patients were followed up for one year after discharge,and the readmission rate and mortality due to CAP were counted.SPSS statistics 22.0 was used for statistical analysis.Data comparison between two groups was performed by using t test,χ^(2) test or Fisher′s exact probability test depending on data type.Binary logistic regression model was adopted to analyze the related factors affecting the QoL at discharge in the elderly CAP survivors in emergency department.Results Among the 310 subjected patients,43(13.87%)died during hospitalization,and 267(86.13%)survived at discharge.There were 260 valid questionnaires collected in the 267 survivors,with an effective recovery rate of 97.39%.The total score of the SF-36 scale of the enrolled subjects was(573.63±65.69)points.The score of each dimension and the total score of the SF-36 scale at discharge were significantly lower in the elderly emergency CAP survivors than the domestic norm(P<0.05).Taking the QoL of elderly emergency CAP survivors at discharge as the dependent variable,binary logistic regression analysis found that length of hospital stay≥14 d(OR=2.201,95%CI 1.373-3.530),underlying diseases>two kinds(OR=3.916,95%CI 1.736-8.832),CRP level>42.03 mg/L(OR=1.889,95%CI 1.027-3.475),hypoproteinemia(OR=2.326,95%CI 1.142-4.737),pneumonia severity index(PSI)grade 4-5(OR=2.210,95%CI 1.279-3.818)and

关 键 词：老年人 急诊病房 社区获得性肺炎 存活者 生活质量 

分 类 号：R563.1[医药卫生—呼吸系统]