老年呼吸机相关肺炎患者死亡的危险因素

目的分析老年呼吸机相关肺炎(VAP)患者死亡的危险因素。方法调查2011年4月—2017年2月某院年龄≥60岁且发生VAP的患者,收集患者的临床资料,包括基本情况、感染情况、预后等,并对其死亡的危险因素进行分析。结果共有老年VAP患者682例,198例患者死亡,病死率为29.03%。APACHEⅡ评分15分(OR=2.482,95%CI=1.473~4.183)、机械通气时间15 d(OR=2.526,95%CI=1.661~3.840)、多重耐药菌感染(OR=3.379,95%CI=2.008~5.686)、真菌感染(OR=3.414,95%CI=1.830~6.370)、使用糖皮质激素(OR=2.075,95%CI=1.265~3.403)、血清清蛋白浓度35 g/L(OR=2.129,95%CI=1.386~3.268)、器官损伤数目≥3个(OR=3.438,95%CI=2.165~5.459)、血糖≥10 mmol/L(OR=1.744,95%CI=1.106~2.751)等8个因素均为老年VAP患者死亡的独立危险因素。结论老年VAP患者死亡与多种因素有关,临床应采取以干预主要危险因素为主的综合防控措施,降低其病死率。

XIE Zhao yun1, XIONG Yun1, QIN Jia lu1, YANG Zhong ling1, YANG Huai2

ObjectiveTo analyze risk factors for death in elderly patients with ventilator associated pneumonia(VAP).MethodsPatients aged≥60 years and with VAP in a hospital from April 2011 to February 2017 were surveyed, clinical data of patients, including basic condition, infection status, and prognosis were collected, risk factors for death were analyzed.ResultsThere were 682 elderly patients with VAP, 198 (29.03%) died. There were 8 independent risk factors for death in elderly VAP patients: APACHE II score>15 points（OR, 2.482 ［95%CI, 1.473-4.183］）, mechanical ventilation>15 days（OR, 2.526 ［95%CI, 1.661-3.840］）, multidrug resistant organism infection（OR, 3.379 ［95%CI, 2.008-5.686］）, fungal infection（OR, 3.414 ［95%CI, 1.830-6.370］）, glucocorticoid use（OR, 2.075［95%CI, 1.265-3.403］）, serum albumin concentration＜35 g/L（OR, 2.129［95%CI, 1.386-3.268］）, number of organ damage≥3（OR, 3.438［95%CI, 2.165-5.459］）, and blood sugar≥10 mmol/L（OR, 1.744［95%CI, 1.106-2.751］）.ConclusionMortality of elderly patients with VAP is related to multiple factors, comprehensive prevention and control measures should be taken to interfere the main risk factors and reduce the mortality.