摘要
目的对≥90岁内科住院患者的特点及影响患者住院期间死亡的因素进行分析。方法回顾性分析2014年1月至12月北京友谊医院医疗保健中心内科≥90岁住院患者141例,根据住院期间死亡与否分为死亡组29例和未死亡组112例,比较2组患者基本情况、入院各项生化指标和入院时日常生活活动能力(ADL)巴氏指数(BI),对影响住院死亡的因素进行分析。采用SPSS 16.0统计软件对数据进行分析。组间比较采用t检验、秩和检验或χ~2检验。多因素logistic回归分析影响患者住院期间死亡的因素。结果与死亡组相比,未死亡组患者急性或陈旧性心肌梗死(AMI/OMI)、心房颤动(AF)、贫血、低白蛋白血症和肿瘤患者比例高,差异具有统计学意义(P<0.05)。BI分值[(37.93±25.27)vs(61.92±23.64)]、血红蛋白(Hb)[(110.11±20.79)vs(120.59±16.83)g/L]和白蛋白(ALB)[(35.42±4.67)vs(38.35±4.25)g/L]水平更低,白细胞(WBC)[(8.89±4.75)×10~9/L vs(6.95±2.26)×109/L]和超敏C-反应蛋白(hs-CRP)[19.44(6.99,40.77)vs5.18(1.27,23.48)mg/L]水平更高,差异具有统计学意义(P<0.05)。Logistic回归分析结果表明重度和极重度失能(OR=5.055,95%CI 1.961~13.026,P=0.001)、贫血(OR=4.796,95%CI 1.795~12.813,P=0.002)和WBC(OR=1.233,95%CI 1.046~1.455,P=0.013)水平为住院患者死亡的危险因素。结论≥90岁内科住院患者入院后应积极改善日常生活能力,并积极纠正贫血状态。
Objective To analyze the characteristics of nonagenarian inpatients in internal medicine department and investigate the influencing factors associated with the in-hospital mortality. Methods Medical records of 141 over-90-year-old inpatients admitted in our department from January to December 2014 were collected and then retrospectively analyzed. According to their in-hospital outcome,the patients were divided into death group（ n = 29） and survival group（ n = 112）. The general information,results of biochemical indices at admission,Barthel index（ BI） activities of daily living（ ADL） were compared between the 2 groups for influencing factors associated with the in-hospital mortality. SPSS statistics 16. 0 was used to analyze the data. Student＇s t test,Wilcoxon rank sum test or Chi-square test was employed for the comparison between groups. Multivariate logistic regression analysis was adopted to explore the factors affecting in-hospital mortality. Results Compared with the patients in the survival group,those from the death group had higher ratios of acute or old myocardial infarction,atrial fibrillation,anemia,hypoalbuminemia and cancer（ P 0. 05）,lower BI[（ 37. 93 ± 25. 27） vs（ 61. 92 ± 23. 64） ],and decreased levels of hemoglobin [（ 110. 11 ± 20. 79） vs（ 120. 59 ± 16. 83） g/L] and albumin [（ 35. 42 ± 4. 67） vs（ 38. 35 ± 4. 25） g/L],but larger white blood cell count [（ 8. 89 ± 4. 75） × 109/L vs（ 6. 95 ± 2. 26） ×109/L]and higher level of high sensitivity C-reactive protein [19. 44（ 6. 99,40. 77） vs 5. 18（ 1. 27,23. 48） mg/L]（ all P 0. 05）.Logistic regression analysis indicated that severe and very severe disability（ OR = 5. 055,95% CI 1. 961-13. 026,P = 0. 001）,anemia（ OR = 4. 796,95% CI 1. 795-12. 813,P = 0. 002）,and white blood cell count（ OR = 1. 233,95% CI 1. 046-1. 455,P = 0. 013）were risk factors for in-hospital death in the cohort. Conclusion The inpatients aged 90 or above should actively improve their ability of daily living after admission,and the state of anemia should be corrected initiatively.
作者
黄蔚
孙颖
HUANG Wei;SUN Ying(Internal Medicine Department of Health Care Center,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)
出处
《中华老年多器官疾病杂志》
2018年第6期430-433,共4页
Chinese Journal of Multiple Organ Diseases in the Elderly
