摘要
目的探讨ICU收治重症肺炎的预后影响因素,为重症肺炎治疗及预后判断提供依据。方法收集2010年1月1日至2017年12月31日上海市第一人民医院ICU收治的135例重症肺炎患者的临床资料及随访资料,采用Logistic回归分析临床预后的危险因素。结果收治重症肺炎患者的总体院内病死率、28 d病死率及90 d病死率分别为22.2%、37%及40.7%。年龄>55、序贯器官衰竭估计(SOFA)评分>5、急性生理学及慢性健康状况Ⅱ(APACHⅡ)评分>12、合并多器官功能障碍综合征(MODS)、GCS评分<8、PLT<85×109/L、BUN>7.1 mmol/L、ALB<30 g/L、GLU≥10 mmol/L、CRP≥100mg/L与重症肺炎患者的28 d死亡及90 d死亡相关,Logistic回归分析提示年龄>55岁是影响28 d死亡及90 d死亡的独立危险因素,而合并MODS提示较高的90 d病死率。结论年龄、SOFA评分、APACHII评分、合并MODS、GCS评分(意识障碍)、营养状态(ALB)、血小板减少、尿素氮升高、血糖升高、CRP升高与重症肺炎的预后相关,并可作为患者预后判断、指导治疗的指标。
Objective To investigate the prognostic factors of severe acute pneumonia in the ICU, and provide basis for the treatment and prognosis of severe pneumonia. Methods Retrospectively collected clinical data and follow-up data of 135 patients with severe pneumonia admitted to the ICU of Shanghai First People′s Hospital from 2010.1.1 to 2017.12.31. Logistic regression analysis was used to analyze the risk factors of clinical prognosis. Results The overall in-hospital mortality, 28-day mortality, and 90-day mortality rate for severe pneumonia patients were 22.2%, 37%, and 40.7%, respectively. Age〉 55, （sequential organ failure assessment）SOFA score〉5, （acute physiology and chronic lqealth evaluation Ⅱ）APACH Ⅱ score〉 12, combined MODS, GCS score 〈8, PLT 〈85×10 9/L, BUN〉7.1 mmol/L, ALB〈30 g/L, GLU〉10 mmol/L, CRP≥100 mg/L was associated with 28-day mortality and 90-day mortality in patients with severe pneumonia. Logistic regression analysis suggested that age〉55 years was an independent risk factor for 28-day mortality and 90-day mortality, while combined MODS indicated a higher 90-day death. rate. Conclusions Age, SOFA score, APACH Ⅱ score, combined MODS, GCS score （impaired consciousness）, nutritional status （ALB）, thrombocytopenia, elevated urea nitrogen, elevated blood glucose, elevated CRP are prognosis factors of severe pneumonia, whose might guide treatment in clinical practice.
作者
滕晓蕾
谢云
谢晖
田锐
金卫
王瑞兰
Teng Xiaolei;Xie Yun;Xie Hui;Tian Rui;Jin Wei;Wang Ruilan(Emergency Department of Shanghai First People′s Hospital.Shanghai 201620,China)
出处
《中华肺部疾病杂志（电子版）》
CAS
2018年第3期299-303,共5页
Chinese Journal of Lung Diseases(Electronic Edition)
基金
上海市卫生计生系统重要薄弱学科建设计划(2016ZB0205)
关键词
重症肺炎
重症监护
序贯器官衰竭估计评分
急性生理学及慢性健康状况Ⅱ评分
预后因素
Severe pneumonia
Intensive care unit
Sequential organ failure assessment score
Acute physiology and chronic lqealth evaluation Ⅱ score
Prognostic factors
