摘要
目的探讨高龄失能细菌性肺炎脓毒症患者的临床特征及预后影响因素。方法采用回顾性队列研究,收集高龄(年龄≥80岁)失能细菌性肺炎脓毒症患者的基本特征及临床特征等资料。观察其入科后30 d的存活情况,比较不同情况患者临床特征的差异性,采用COX回归模型分析患者预后的影响因素。结果共纳入63例患者,平均年龄(86.84±4.83)岁,其中生存组49例,死亡组14例。与生存组相比,死亡组入科时序贯器官衰竭评估(SOFA)评分、△SOFA评分、急性生理与慢性健康状况评估(APACHEⅡ)评分更高,治疗前后的氧合指数、血清白蛋白、内生肌酐清除率更低,治疗前后的D-二聚体更高,液体复苏中静脉补充的晶体液、联用20%人血白蛋白注射液及使用血管活性药物的比例更高,差异有统计学意义(P<0.05)。COX回归分析显示,入科时APACHEⅡ评分(HR=1.268,95%CI:1.093~1.471,P=0.002),治疗后24 h内尿素/肌酐(HR=1.070,95%CI:1.015~1.128,P=0.011),液体复苏期间联用20%人血白蛋白注射液(HR=0.077,95%CI:0.010~0.624,P=0.016)是患者30 d生存的影响因素。结论高龄失能细菌性肺炎脓毒症患者入科时APACHEⅡ评分、治疗后24 h内尿素/肌酐对预测死亡高风险的患者具有价值,复苏时联用20%人血白蛋白注射液可改善预后。
Objective To explore the clinical characteristics and prognostic factors of elderly patients with bacterial pneumonia and sepsis.Methods A retrospective cohort study was conducted to collect the basic characteristics and clinical features of the elderly(age≥80 years old)disabled patients with bacterial pneumonia and sepsis.The survival status of the patients was observed 30 days after admission,and the differences of clinical characteristics of the patients in different states were compared.COX regression model was used to analyze the influencing factors of patients’prognosis.Results A total of 63 patients were included,with an average age of(86.84±4.83)years,including 49 cases in the survival group and 14 cases in the death group.Compared with the survival group,the death group had higher sequential organ failure assessment(SOFA)score,△SOFA score,and acute physiological and chronic health evaluation(APACHE Ⅱ)score at admission,lower oxygenation index,serum albumin,and endogenous creatinine clearance before and after treatment,higher D-dimer levels before and after treatment,and higher proportions of intravenous crystalloid fluid supplementation,combined use of 20%human serum albumin injection,and use of vasoactive drugs during fluid resuscitation,with statistically significant differences(P<0.05).COX regression analysis showed that APACHE Ⅱ score at admission(HR=1.268,95%CI:1.093-1.471,P=0.002),urea/creatinine within 24 hours after treatment(HR=1.070,95%CI:1.015-1.128,P=0.011),the combination of 20%human albumin injection during fluid resuscitation(HR=0.077,95%CI:0.010-0.624,P=0.016)were influential factors in the survival of patients at 30 days.Conclusion APACHE Ⅱ score at admission and urea/creatinine within 24 hours after treatment are valuable for predicting high risk of death in elderly and disabled patients with bacterial pneumonia and sepsis.Combined treatment with 20%human blood albumin injection can improve prognosis.
作者
石郑雨
雷森
SHI Zhengyu;LEI Sen(Department of Intensive Care Medicine,Chengdu Eighth People’s Hospital,Chengdu,Sichuan 610000,China;Department of Cardiovascular Medicine,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)
出处
《重庆医学》
CAS
2024年第10期1537-1542,共6页
Chongqing medicine
关键词
脓毒症
高龄
失能
临床特征
预后
sepsis
elderly
disability
clinical characteristics
prognosis
