查看更多>>摘要：目的 探讨机械通气治疗重症肺炎预后的影响因素。 方法 病例对照研究。抽取2020年12月至2022年12月于洛阳市第一人民医院呼吸与危重症医学科行机械通气治疗的90例重症肺炎患者，治疗后根据预后(入院28 d后病情转归情况)分为死亡组与生存组，收集两组一般资料(性别、年龄、体质指数、吸烟史、酗酒史)、入院时生命体征指标(心率、呼吸频率、体温)、入院时生化指标(血清白蛋白、血红蛋白、白细胞计数、降钙素原、C-反应蛋白、血肌酐)、急性生理学及慢性健康状况评分系统Ⅱ评分(APACHE Ⅱ)、基础疾病种类、合并感染性休克、合并呼吸衰竭、器官受累数量(≥3个)、痰培养结果等资料。采用多因素Logistic回归分析评估机械通气治疗重症肺炎患者死亡的相关危险因素。 结果 90例患者入院28 d内死亡38例(死亡组)，存活52例(生存组)，病死率为42.22%(38/90)。死亡组与生存组体质指数、白蛋白、降钙素原、血肌酐、APACHE Ⅱ评分、合并感染性休克、合并呼吸衰竭、器官受累数量比较，差异均有统计学意义(P均<0.05)。Logistic回归分析结果显示，体质指数、白蛋白、降钙素原、血肌酐、APACHE Ⅱ评分、合并感染性休克、合并呼吸衰竭、器官受累数量均是机械通气治疗重症肺炎患者死亡的危险因素(OR均>1，P均<0.05)。 结论 重症肺炎患者应用机械通气治疗后死亡风险仍较高，其危险因素包括体质指数、白蛋白、降钙素原、血肌酐、APACHE Ⅱ评分、合并感染性休克、合并呼吸衰竭、器官受累数量。 Objective To investigate the influencing factors of prognosis of mechanical ventilation therapy for severe pneumonia. Methods In this case-control study, 90 patients with severe pneumonia requiring mechanical ventilation therapy in Department of Pulmonary and Critical Care Medicine of Luoyang First People’s Hospital from December 2020 to December 2022 were selected, and they were divided into death group and survival group according to prognostic outcome within 28 days after admission. General information (gender, age, body mass index, smoking history, alcohol abuse history), baseline vital signs indicators (heart rate, respiratory rate, body temperature), baseline biochemical indicators (serum albumin, hemoglobin, white blood cell count, procalcitonin, C-reactive protein, serum creatinine), acute physiology and chronic health evaluation Ⅱ scoring system (APACHEⅡ) score, type of underlying disease, concurrent septic shock, concurrent respiratory failure, number of organs involved (≥3), and bacteriologic cultures of sputum of all participants were recorded. Risk factors associated with mortality in patients with severe pneumonia treated by sequential mechanical ventilation were screened using multivariate logistic regression analysis. Results Of the 90 patients, 38 patients died (death group), and 52 patients survived (survival group) within 28 days after admission, with a case fatality rate of 42.22%(38/90). The differences in body mass index, serum albumin, procalcitonin, serum creatinine, APACHE Ⅱ score, concurrent septic shock, concurrent respiratory failure, and number of organs involved between the death group and the survival group were statistically significant (all P<0.05). The results of logistic regression analysis showed that body mass index, serum albumin, procalcitonin, serum creatinine, APACHE Ⅱ score, concurrent septic shock, concurrent respiratory failure, and number of organs involved were risk factors for death in patients with severe pneumonia treated by mechanical ventilation (allOR>1, allP<0.05). Conclusions Patients with severe pneumonia suffer a high risk of mortality after sequential mechanical ventilation, and the risk factors include body mass index, serum albumin, procalcitonin, serum creatinine, APACHE Ⅱ score, concurrent septic shock, concurrent respiratory failure, and number of organs involved.
万方数据