肺部疾病引发全身炎症反应综合征的老年患者死亡因素分析

目的分析肺部疾病引发全身炎症反应综合征（SIRS）的老年患者病情死亡因素。方法选择2009年9月至2010年12月入住浙江大学医学院附属第一医院中心重症监护病房因肺部疾病引发SIRS的老年患者50例,根据预后情况分为存活组（18例）和死亡组（32例）。检测所有入院患者24h内的血清胆碱酯酶（ChE）、白蛋白（ALB）、D-二聚体、乳酸及C反应蛋白（CRP）水平,并进行急性病生理学和长期健康评价（APACHE）Ⅱ评分。结果存活组和死亡组之间比较,肺部疾病引发SIRS患者的血乳酸、ALB及APACHEⅡ评分差异无统计学意义（P均〉0.05）,而年龄、血浆D-二聚体、CRP及ChE方面,差异均具有统计学意义（P均〈0.05）。Logistic回归结果表明,影响肺部疾病引起SIRS的老年患者预后的独立危险因素仅有ChE一项（β=-0.016,P=0.040）。受试者工作特征曲线（ROC）分析显示,以ChE预测SIRS的老年患者预后的ROC曲线下面积为0.839,S.E.=0.057,P=0.000;当ChE=98.5U/L时,敏感度为88.9;1-特异度为0.25,以此切点对患者的预后具有较好的预测价值。结论 ChE可能参与了老年SIRS的发生和发展过程,对这类患者的病情发展转归有一定的预测作用,指标稳定,受干扰因素少。

Risk factors analysis on the elderly with systemic inflammatory response syndrome caused by pulmonary disease

Objective To explore the risk factors on the elderly with systemic inflammatory response syndrome (SIRS) caused by pulmonary disease. Methods The clinical data of 50 elderly patients with SIRS caused by pulmonary disease in intensive care medicine (ICU) department of the first hospital affiliated to Zhejiang university medical college from September 2009 to December 2010 were retrospectively analyzed. All the patients were divided into death group (32 cases) and survival group (18 cases) on the basis of the...