摘要
目的 探讨重症肺炎患者气管插管后与死亡相关的独立危险因素分析,为及早干预提供临床依据.方法 回顾性分析2018年2月～2023年2月四川大学华西医院急诊科收治的507例因重症肺炎行气管插管患者的临床资料.研究结局为插管后28天是否死亡,将患者分为存活组和死亡组,比较两组患者的一般资料(年龄、体重、性别、合并慢性疾病、插管前使用诱导剂、是否脓毒症)、插管后12h各类理化指标、插管后1h内是否发生低血压的差异.组间比较差异有统计学意义的指标纳入单因素和多因素Logistic回归分析,分析重症肺炎患者气管插管后28天死亡的影响因素.结果 两组患者的一般资料及插管后各项指标比较,年龄、体重、插管前使用诱导剂、合并慢性阻塞性肺疾病或脓毒症、插管后乳酸增高、插管后低血压比较,差异有统计学意义(P＜0.05);单因素和多因素Logistic回归分析结果显示,年龄、体重、插管前使用诱导剂、高乳酸血症、合并慢性阻塞性肺疾病、脓毒症和插管后低血压是死亡的风险因素.结论 年龄、低体重、插管前使用诱导剂、插管后乳酸水平增高、合并慢性阻塞性肺疾病或脓毒症、插管后低血压是重症肺炎患者插管后28天死亡的独立危险因素,针对该类患者应及早进行临床干预改善患者预后.
Abstract
Objective To explore the independent risk factors of death in patients with severe pneumonia after endotracheal intuba-tion(ETI),so as to provide clinical basis for early intervention.Methods The data of 507 patients with severe pneumonia who under-went ETI in the Department of Emergency,West China Hospital,Sichuan University from February 2018 to February 2023 were analyzed retrospectively.The outcome of the study was whether the patients died 28 days after intubation.The patients were divided into survival group and death group.The general data(age,body weight,gender,chronic disease,use of inducer before intubation,sepsis),physical and chemical indexes 12 hours after intubation and hypotension within 1 hour after intubation were compared between the two groups.Sig-nificant differences between groups were included in univariate and multivariate Logistic regression analysis to analyze the influencing fac-tors of death 28 days after endotracheal intubation in patients with severe pneumonia.Results There were significant differences in age,body weight,use of inducer before intubation,complication of chronic obstructive pulmonary disease or sepsis,increase of lactic acid after intubation and hypotension after intubation between the two groups(P＜0.05).Univariate and multivariate Logistic regression analysis showed that age,body weight,use of inducer before intubation,hyperlactic acidemia,chronic obstructive pulmonary disease,sepsis and hypotension after intubation were risk factors for death.Conclusion Age,low body weight,use of inducer before intubation,increased of lactic acid level after intubation,complication of chronic obstructive pulmonary disease or sepsis and hypotension after intubation are in-dependent risk factors for death 28 days after intubation in patients with severe pneumonia.Early clinical intervention should be carried out to improve the prognosis of patients with severe pneumonia.
基金项目
北京协和医学基金-睿E(睿意)急诊医学科研专项(睿意基金22222012003)
维普
万方数据