摘要
目的探讨老年重症肺炎病原菌分布情况及导致死亡风险的危险因素预测价值。方法回顾性分析2021年6月—2024年6月中国航天科工集团七三一医院老年医学科收治的105例老年重症肺炎患者临床资料。根据治疗28 d预后情况将患者分为生存组(n=76)及死亡组(n=29)。分析病原菌分布情况及各危险因素对老年重症肺炎患者死亡风险的预测价值。结果105例患者共检出病原菌143株,革兰阴性菌占61.54%(88株),革兰阳性菌占30.07%(43株),真菌占8.39%(12株)。死亡组年龄为(75.25±8.82)岁,生存组年龄(69.23±7.62)岁,死亡组高于生存组,差异有统计学意义(P<0.05)。死亡组慢性阻塞性肺疾病、机械通气、体内导管植入比例分别为34.48%、68.97%、79.31%,生存组分别为10.83%、19.74%、50.00%,死亡组高于生存组,差异均有统计学意义(P<0.05)。死亡组急性生理及慢性健康状况评分(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、白细胞计数、血乳酸、C反应蛋白(C-reactive protein,CRP)、降钙素原(procalcitonin,PCT)、血小板计数、凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activited partial homboplastin time,APTT)、凝血酶时间(thrombin time,TT)、D-二聚体分别为(24.07±4.24)分、(20.25±4.12)×10^(9)/L、(5.89±1.23)mmol/L、(110.38±27.54)mg/L、(12.36±3.17)ng/mL、(18.68±2.57)s、(45.15±9.47)s、(20.85±5.16)s、(7.24±2.15)s,生存组分别为(18.88±3.15)分、(17.63±3.65)×10^(9)/L、(4.25±1.14)mmol/L、(68.63±16.19)mg/L、(9.14±3.25)ng/m L、(16.35±2.62)s、(38.53±8.63)s、(16.34±2.73)s、(4.12±1.01)s,死亡组高于生存组,差异均有统计学意义(P<0.05)。机械通气、APACHEⅡ评分、血乳酸、CRP、PCT、D-二聚体是老年重症肺炎死亡的危险因素(P<0.05)。APACHEⅡ评分、血乳酸、CRP、D-二聚体预测老年重症肺炎患者死亡的AUC(95%CI)分别为0.845(0.761~0.908)、0.829(0.743~0.896)、0.894(0.819~0.946)、0.895(0.820~0.947),对老年重症肺炎患者的死亡有预测价值。结论老年重症肺炎的致病菌以革兰阴性菌为主,机械通气、APACHEⅡ评分升高、高血乳酸、CRP、PCT及D-二聚体水平与不良预后密切相关,可作为早期风险分层及干预的重要参考指标。
Objective To investigate the distribution of pathogens in elderly patients with severe pneumonia and the predictive value of risk factors for mortality.Methods A retrospective analysis was conducted on the clinical data of 105 elderly patients with severe pneumonia admitted to the Department of Geriatrics at China Aerospace Science and Industry Corporation 731 Hospital from June 2021 to June 2024.Patients were divided into survival and mortality groups based on their 28-day treatment outcomes.The distribution of pathogens was analyzed.Univariate and multivariate logistic regression analyses were performed to explore factors associated with prognosis,and the predictive value of each risk factor for mortality in elderly patients with severe pneumonia was assessed using receiver operating characteristic(ROC)curves.Results A total of 143 pathogens were detected in the 105 patients,with Gram-negative bacteria accounting for 61.54%(88 strains),Gram-positive bacteria 30.07%(43 strains),and fungi 8.39%(12 strains).The age of the death group was(75.25±8.82)years,and that of the survival group was(69.23±7.62)years.The age of the death group was higher than that of the survival group,and the difference was statistically significant(P<0.05).The proportions of chronic obstructive pulmonary disease,mechanical ventilation,and in vivo catheterization in the death group were 34.48%,68.97%,and 79.31%,respectively,while those in the survival group were 10.83%,19.74%,and 50.00%,respectively.All the above proportions in the death group were higher than those in the survival group,and the differences were all statistically significant(P<0.05).In the death group,the acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,white blood cell count,blood lactic acid level,C-reactive protein(CRP),procalcitonin(PCT),prothrombin time(PT),activited partial homboplastin time(APTT),thrombin time(TT),and D-dimer were(24.07±4.24)points,(20.25±4.12)×10^(9)/L,(5.89±1.23)mmol/L,(110.38±27.54)mg/L,(12.36±3.17)ng/mL,(18.68±2.57)s,(45.15±9.47)s,(20.85±5.16)s,and(7.24±2.15)mg/L,respectively;in the survival group,the corresponding values were(18.88±3.15)points,(17.63±3.65)×10^(9)/L,(4.25±1.14)mmol/L,(68.63±16.19)mg/L,(9.14±3.25)ng/mL,(16.35±2.62)s,(38.53±8.63)s,(16.34±2.73)s,and(4.12±1.01)mg/L,respectively.All the above indicators in the death group were higher than those in the survival group,and the differences were all statistically significant(P<0.05).Mechanical ventilation,APACHEⅡscore,blood lactic acid level,CRP level,PCT level,and D-dimer level were identified as risk factors for death in elderly patients with severe pneumonia(P<0.05).The AUC(95%CI)values of APACHEⅡscore,blood lactic acid,CRP,and D-dimer in predicting death among elderly patients with severe pneumonia are 0.845(0.761-0.908),0.829(0.743-0.896),0.894(0.819-0.946),and 0.895(0.820-0.947),respectively,had predictive value for mortality in elderly patients with severe pneumonia.Conclusion The pathogens causing severe pneumonia in the elderly are mainly Gram-negative bacteria.Mechanical ventilation,elevated APACHEⅡscore,hyperlactatemia,and elevated levels of CRP,PCT,and D-dimer are closely related to poor prognosis and can serve as important reference indicators for early risk stratification and intervention.
作者
张婷婷
王静
杨丽
ZHANG Tingting;WANG Jing;YANG Li(Department of Geriatric,China Aerospace Science and Industry Corporation 731 Hospital,Beijing 100074,China)
出处
《中国卫生标准管理》
2025年第14期91-95,共5页
China Health Standard Management
基金
中国航天科工集团七三一医院院内科研课题(2022-QSYN-20)。
关键词
老年
重症肺炎
病原菌
预后
影响因素
危险因素
old age
severe pneumonia
pathogenic bacteria
prognosis
influential factors
risk factors
