在线办公
期刊论坛
主 管
中国人民解放军总医院
主 办
中国人民解放军总医院老年心血管病研究所
中国科技出版传媒股份有限公司
编 辑
中华老年多器官疾病杂志编辑委员会
100853, 北京市复兴路28号
电话:010-66936756
传真:010-66936756
E-mail: zhlndqg@mode301.cn
创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
入院营养状况对老年CAP严重程度及预后的影响
The effect of nutritional status on the severity and prognosis of CAP in elderly patients at admission
投稿时间:2019-07-11  修订日期:2019-09-17
DOI:
中文关键词:  社区获得性肺炎;老年;肺炎严重程度;营养不良风险;
英文关键词:community acquired pneumonia; elderly; severity of pneumonia; malnutrition risk;
基金项目:
作者单位E-mail
郝小飞 首都医科大学附属北京友谊医院医疗保健中心内科 haoxiaofei1992fly@163.com 
姜春燕 首都医科大学附属北京友谊医院医疗保健中心内科 jchy12368@sina.com  
摘要点击次数: 89
全文下载次数: 
中文摘要:
      目的:应用肺炎严重指数(Pneumonia Severity Index,PSI)量表进行肺炎严重程度评估,应用营养风险筛查 (Nutritional Risk Screening 2002,NRS2002)表进行入院营养状况调查,探讨入院营养状况对老年CAP严重程度及临床预后的影响。 方法:本研究采用定点连续抽样的方法,以2018年1月至2018年9月期间在首都医科大学附属北京友谊医院医疗保健中心内科住院的老年CAP患者为研究对象,入院24h内应用PSI量表进行肺炎严重程度评估,72h内应用NRS2002量表进行营养状况调查,记录研究对象的基本资料、体格检查数据、实验室数据、老年综合评估量表、临床预后等;根据肺炎严重程度分为2组:非高危组与高危组,采用卡方检验、非参数检验、t检验统计方法比较各组营养状况及年龄、体重指数(Body Mass Index ,BMI)、手握力、合并症等指标,采用多因素 Logistic 逐步回归分析探讨患者发生高危肺炎的影响因素,采用卡方检验比较入院营养状况对老年CAP住院患者临床预后的影响。 结果:本研究共纳入150例老年CAP住院患者,平均年龄(85.29?7.349)岁。PSI评估高危肺炎组51例(34%)、非高危肺炎组99例(66%),NRS2002评估营养不良风险者85例(56.7%)、营养正常者65例(43.3%)。两组患者比较,年龄、营养状况、口腔缺齿义齿、体力及握力情况、认知功能、入院日常生活能力评分、合并脑血管病比例、合并房颤比例、合并心功能不全比例、合并心肌梗死比例、合并肝病比例、合并肾病(急、慢性肾功能不全)比例、合并胸腔积液比例、红细胞计数、血红蛋白、血清白蛋白、血尿素氮、血肌酐、红细胞体积分布宽度(Red blood cell volume Distribution Width,RDW)差异有统计学意义(P<0.05)。其中营养不良风险、心功能不全、口腔缺齿/义齿、血红细胞体积分布宽度增高、血尿素氮增高、入院日常生活能力评分减低是老年CAP住院患者发生高危肺炎的影响因素(P<0.05),高危组肺炎患者住院时间长、死亡比例高(P<0.05);在所有入组患者中,合并营养不良风险者与营养正常者比较,死亡比例高,预后差((P<0.05)。 结论:老年CAP住院患者高危肺炎发生率高,营养不良风险评分增高、心功能不全、口腔缺齿/义齿、血红细胞体积分布宽度增高、血尿素氮增高、入院日常生活能力评分减低为高危肺炎的危险因素,合并营养不良风险的老年CAP住院患者死亡率高、预后差。
英文摘要:
      Objective:To assess the severity of CAP(Community-Acquired Pneumonia) in elderly patients using PSI(Pneumonia Severity Index), to assess the nutritional status using NRS2002(Nutritional Risk Screening 2002) ,to explore the effect of nutritional status on the severity and clinical prognosis of CAP in elderly patients. Methods: This study used fixed-point continuous sampling, inpatients with community-acquired pneumonia aged over 65 years in Health Care Center, Beijing Friendship Hospital were enrolled in this investigation from January 2018 to September 2018. The severity of pneumonia were assessed with the PSI within 24h after admission. The nutritional status were assessed with NRS2002 within 72h after admission. We recorded the basic data, anthropometric indicators,laboratory results of the patients,comprehensive assessment form for the elderly had also been recorded.All patients were divided into non-high-risk pneumonia group and high-risk pneumonia group according to PSI scores, then compared their nutritional status ,age, BMI(body mass index), hand grip strength, comorbidity and other indicators of these two groups using Chi-square test, non-parametric test and t-test. Multivariable Logistic stepwise regression analysis was performed to investigate the risk factors of patients with high-risk pneumonia. Chi-square test was used to compare the effect of nutritional status on the clinical prognosis of CAP in elderly inpatients. Results: A total of 150 patients were enrolled. They were at the age(85.28?7.418) years old. 51 subjects (34%) were high-risk pneumonia and 99 subjects (66%) were non-high-risk pneumonia. According to the NRS2002 standard, there were 85 cases(56.7%) at malnutritional Risk,65 cases(43.3%)at Normalized. Age, malnutrition, oral edema, physical and grip strength, cognitive function, spasticity, depression, daily living ability score, proportion of CAP with cerebrovascular disease,proportion of CAP with atrial fibrillation, proportion of CAP with heart dysfunction , proportion of CAP with myocardial infarction, proportion of CAP with liver disease, proportion of CAP with renal disease, proportion of CAP with pleural effusion, red blood cell count, hemoglobin, serum albumin, blood urea nitrogen, serum creatinine, RDW (Red blood cell volume Distribution Width)showed significant difference(P<0.05). According to the results of multivariable Logistic stepwise regression analysis,malnutrition, heart dysfunction ,oral edema, RDW ,blood urea nitrogen and daily living ability score were risk factors of high-risk pneumonia (P<0.05), and high-risk pneumonia patients had longer hospital stays and higher death rates (P<0.05). (P<0.05). The lengths of stay and the rate of mortality in high-risk group was longer or higher than that in non-high-risk group (P<0.05).And patients combining malnutrition had higher rate of mortality (P<0.05). Conclusions: High-risk pneumonia has a higher incidence in elderly CAP hospitalized patients, and malnutrition is an independent risk factor for high-risk pneumonia,and elderly CAP patients with malnutritional have high mortality and worse prognosis. malnutrition, heart dysfunction ,oral edema, RDW ,blood urea nitrogen and daily living ability score were risk factors of high-risk pneumonia.
下载全文   查看/发表评论    下载PDF阅读器
关闭