目的 探讨老年人吸入性肺炎(AsP)的疾病特点及其相关危险因素.方法 回顾性病例对照研究,收集2018年6月1日至2022年7月31日入住首都医科大学附属北京积水潭医院年龄≥60岁、出院主要诊断为AsP的92例患者,以及同期入院1∶1数量匹配的92例老年非AsP患者的临床资料进行分析.结果 AsP组年龄(80.88±9.41)岁、男性57例(62.0％);非AsP组年龄(77.74±10.98)岁、男性52例(56.5％),两组患者年龄、性别差异均无统计学意义(t=1.973、x2=0.661,P=0.060、0.416).单因素分析结果显示,AsP组患者入院时体质指数(BMI)、日常生活活动能力(ADL)评分均低于非AsP组,存在胃食管反流病、急性外伤、脑血管病、脑梗死/脑出血史及脑梗后遗症的比例均高于非AsP组,住院期间留置鼻饲管与气管插管比例也显著高于非AsP组(均P＜0.05);AsP组首次血清白细胞计数、中性粒细胞百分比、降钙素原均高于非AsP组,住院期间上述三项指标的最大值也均高于非AsP患者,血清白蛋白及前白蛋白水平则低于非AsP组(均P＜0.05);胸部CT提示AsP患者中累计双肺者比例为83.7％(77/92),高于非AsP组比例55.4％(51/92)(x2=8.569、P=0.014).多因素 Logistic 回归分析结果显示,男性(OR=16.206、95％CI:1.268～207.191、P=0.032)是 AsP 发生的危险因素,BMI(OR=0.747、95％CI:0.582～0.959、P=0.022)、入院 ADL 评分(OR=0.945、95％CI:0.903～0.988、P=0.014)是 AsP 发生的保护因素;入院 ADL 评分(OR=0.951、95％CI:0.907～0.982、P=0.043)、肿瘤病史(OR=6.859、95％CI:1.484～31.700、P=0.014)、脑梗死/脑出血史(OR=4.368、95％CI:1.087～17.511、P=0.038)、慢性肾功能不全史(OR=5.820、95％CI:1.445～23.440、P=0.013)与急性呼吸衰竭(OR=5.281、95％CI:1.237～22.545、P=0.013)、心肌梗死(OR=9.466、95％CI:2.151～41.660、P=0.003)是影响老年人肺炎预后的独立相关因素.结论 老年人AsP更多见于男性、低BMI及ADL下降的人群.未显示AsP人群的死亡风险高于非AsP者,但AsP与不良预后存在共同的危险因素,临床应予足够重视、及早干预.
Risk factors and prognosis of aspiration pneumonia in the elderly
Objective To analyze the disease characteristics of aspiration pneumonia and its risk factors.Methods In this retrospective case-control study,analysis was conducted on data from 92 patients aged ≥ 60 years admitted to Beijing Jishuitan Hospital,Capital Medical University between June 1,2018 and July 31,2022,with aspiration pneumonia(AsP)as the primary diagnosis at the time of hospital discharge and from non-AsP patients admitted during the same period.The number of participants was matched at a 1:1 ratio.Results The average age of the AsP group was(80.88± 9.41)years and 57(62.0％)were men.The average age of the control group was(77.74±10.98)years and 52(56.5％)were men.There was no statistically significant difference in age and sex ratio(age:t=1.973,P=0.060;sex ratio:x2=0.661,P=0.416).Univariate analysis showed that,at admission,body mass index(BMI)and activities of daily living(ADL)scores of the AsP group were lower than those of the non-AsP group,the proportions of patients with gastroesophageal reflux disease,acute trauma,cerebrovascular disease,history of cerebral infarction/hemorrhage and sequelae of cerebrovascular disease were higher than those of the non-AsP group(all P＜0.05),and the proportions of patients receiving feeding via indwelling nasogastric intubation and tracheal intubation were also higher in the AsP group(all P＜0.05).The white blood cell count,the percentage of neutrophils and the procalcitonin level in the first round of tests were higher in the AsP group than those in the non-AsP group and the maximum values of the above parameters during hospitalization were also higher than those in non-AsP patients,while the levels of albumin and prealbumin were lower than those in the non-AsP group(P＜0.05 for all).Chest CT showed that 83.7％(77/92)of patients with AsP had bilateral pneumonia,higher than 55.4％(51/92)in the non-AsP group(x2=8.569,P=0.014).Multivariate Logistic regression analysis showed that male sex(OR=16.206,95％CI:1.268-207.191,P=0.032)was a risk factor for AsP,and BMI(OR=0.747,95％CI:0.582-0.959,P=0.022)and ADL score at admission(OR=0.945,95％CI:0.903-0.988,P=0.014)were protective factors against AsP.ADL score at admission(OR=0.951,95％CI:0.907-0.982,P=0.043),tumor history(OR=6.859,95％CI:1.484-31.700,P=0.014),history of cerebral infarction/intracerebral hemorrhage(OR=4.368,95％CI:1.087-17.511,P=0.038),history of chronic renal insufficiency(OR=5.820,95％CI:1.445-23.440,P=0.013),acute respiratory failure(OR=5.281,95％CI:1.237-22.545,P=0.013)and myocardial infarction(OR=9.466,95％CI:2.151-41.660,P=0.003)were independent factors affecting the prognosis of pneumonia in the elderly.Conclusions Aspiration pneumonia in the elderly is more common in men and in individuals with low BMI and low ADL scores.There is no increased risk of mortality in people with AsP,compared with people without AsP,but some risk factors in AsP patients may lead to poor prognosis,calling for increased awareness and early intervention in clinical practice.
万方数据
维普
