高龄重症社区获得性肺炎并心血管事件患者预后不良因素分析
Prognosis and coping strategies of elderly patients with severe community-acquired pneumonia with cardiovascular events

刘丽.高龄重症社区获得性肺炎并心血管事件患者预后不良因素分析[J].内科急危重症杂志,2021,27(2):138-141

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DOI：10.11768/nkjwzzzz20210213

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作者	单位	E-mail
刘丽	四川省攀枝花市第二人民医院	1078940266@qq.com

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中文摘要:

目的：分析高龄重症社区获得性肺炎（CAP）合并心血管事件患者预后不良因素，探讨临床诊疗策略。方法：将116例高龄重症CAP并发心血管事件患者按照住院30d内的预后分为治愈出院组（54例）和预后不良组（62例）。分析2组患者性别、年龄、入院时CURB65评分（包括意识障碍、尿素氮、呼吸频率、血压、年龄）、肺炎严重指数（PSI评分）及CRB65评分（包括意识障碍、呼吸频率、血压、年龄）、重症肺炎评判主要标准及次要标准构成情况、住院前心血管事件发生史、住院期间心血管事件类别、辅助治疗措施、初始疗效、并发症情况等，将组间差异有统计学意义的指标纳入多因素Logistic回归分析，分析高龄重症CAP并心血管事件患者预后不良的危险因素。结果：住院期间新发心律失常47例（40.52%）、急性心肌梗死33例（28.45%）、心绞痛 21例（18.10%）、急性心力衰竭 15例（ 12.93%）。2组患者年龄、入院时CURB65评分、PSI评分、CRB65评分、住院前心血管事件发生史、住院期间心血管事件类别、初始疗效比较，差异有统计学意义（均 P ＜0.05）。多因素Logistic分析显示，年龄（ OR= 4.156）、入院时CURB65评分5分（ OR= 3.632）、PSIⅤ级（ OR= 4.589）、CRB65评分4分（ OR= 2.445）、住院前有心血管事件史（ OR= 4.625）、住院期间发生急性心肌梗死（ OR= 4.514）、初始治疗无效（ OR= 3.422）为高龄重症CAP并发心血管事件患者预后不良的危险因素。结论：高龄重症CAP并发心血管事件患者预后不良率高，临床应采取措施加以防范，降低不良事件风险率，改善患者预后。

英文摘要:

Objective: To analyze the adverse prognostic factors of elderly patients with severe community-acquired pneumonia (CAP) complicated with cardiovascular events, so as explore the clinical diagnosis and treatment strategies and improve the quality of clinical diagnosis and treatment. Methods: A total of 116 elderly patients with severe CAP and cardiovascular events during hospitalization were divided into the cured group (54 cases) and the deterioration group (62 cases). The gender, age, the CURB65 score at admission, pneumonia severity index (PSI) score, CRB65 score, the composition of major and secondary criteria for severe pneumonia, the occurrence history of cardiovascular events before hospitalization, the types of cardiovascular events during hospitalization, the auxiliary treatment measures, the initial treatment efficacy, and complications were analyzed. The variables with significant difference between two groups were included in the multivariate logistic system. The risk factors of poor prognosis in elderly patients with severe CAP complicated with cardiovascular events were analyzed. Results: The cardiovascular events of 116 elderly patients with severe CAP mainly included new arrhythmia (47 cases, 40.52%), acute myocardial infarction (33 cases, 28.45%), angina pectoris (21 cases, 18.10%), and acute heart failure (15 cases, 12.93%). There were significant differences in age, CURB65 score, PSI score, CRB65 score, incidence of cardiovascular events before hospitalization, types of cardiovascular events during hospitalization, and initial treatment effective rate between the two groups (all P <0.05). Multivariate logistic analysis showed that age ( OR = 4.156), CURB65 score 5 ( OR = 3.632), PSI grade V ( OR = 4.589), CRB65 score 4 ( OR = 2.445), history of cardiovascular events before hospitalization ( OR = 4.625), acute myocardial infarction ( OR = 4.514) and initial treatment failure ( OR = 3.422) were risk factors of poor prognosis in the elderly patients with severe CAP complicated with cardiovascular events. Conclusion: The poor prognosis rate of elderly patients with severe CAP complicated with cardiovascular events is high, the assessment of clinical risk factors should be strengthened and targeted measures should be taken to reduce the risk rate of adverse events and improve the prognosis of patients.