摘要
目的总结北京医院老年流行性感冒(流感)患者的临床特点及分析并发脓毒症的影响因素。方法收集2017年10月至2018年3月该院老年病区确诊为流感的47例老年患者的临床和实验室资料,回顾性分析老年流感患者的临床特点,比较甲乙型流感的临床特点,并探讨流感并发脓毒症的影响因素。结果47例老年流感患者以发热、咳嗽和咳痰为主要症状,比例分别为91.5%、74.5%和66.0%。使用磷酸奥司他韦治疗后,第48小时平均体温[(37.3±0.8)℃]较第24小时[(38.3±0.8)℃]有显著下降(t=5.732,P=0.000);分组比较,甲型流感[(78±18)mm Hg]和乙型流感[(63±7)mm Hg]在诊断时动脉血氧分压(PaO2)差异有统计学意义(t=2.428,P=0.034)。并发脓毒症组与非脓毒症组单因素分析发现,年龄≥80岁,合并冠心病、慢性心功能不全、慢性阻塞性肺疾病(慢阻肺),并发全身炎症反应综合征(SIRS),喘息症状、C反应蛋白、呼吸频率>20次以及无创通气治疗差异有统计学意义。多因素logistic回归分析发现,合并冠心病(β=3.924,P=0.016)、慢阻肺(β=3.232,P=0.034)及喘息症状(β=6.158,P=0.010)是出现脓毒症的独立影响因素。结论老年患者流感多以发热和呼吸道症状为主,磷酸奥司他韦治疗48 h后体温显著降低。合并冠心病、慢阻肺和出现喘息症状是患者并发脓毒症的独立影响因素。
Objective To summarize the clinical features of influenza in the elderly and analyze the influencing factors of influenza complicated with sepsis. Methods Clinical and laboratory data of confirmed influenza in elderly patients in the geriatric ward of Beijing Hospital from October 2017 to March 2018 were collected. The clinical characteristics and treatment of influenza in elderly patients were analyzed and summarized,and the clinical differences of influenza A and influenza B in elderly patients were compared between groups,and the influencing factors of influenza complicated with sepsis were analyzed. Results The main symptoms of 47 elderly influenza patients were fever,cough and sputum,accounting for 91. 5%,74. 5% and 66. 0%,respectively. After the treatment with Oseltamivir Phosphate,the body temperature decreased significantly at 48 h compared with24 h[(37. 3±0. 8)℃ vs.(38. 3±0. 8)℃,t=5. 732,P=0. 000]. As for grouping comparison,there were statistically significant differences in arterial oxygen partial pressure(PaO2)[(78±18)mm Hg vs.(63±7)mm Hg,t=2. 428,P=0. 034]between patients with influenza A and influenza B. Difference was statistically significant between sepsis and non-sepsis group such factors as age≥80,coronary heart disease,chronic cardiac insufficiency,chronic obstructive pulmonary disease(COPD),system inflammatory reaction syndrome(SIRS),wheezing symptoms,C reactive protein,respiratory frequency>20,and non-invasive ventilation.Multivariate logistic regression analysis showed that coronary heart disease(β=3. 924,P=0. 016),COPD(β=3. 232,P=0. 034,)and wheezing symptoms(β=6. 158,P=0. 010)were independent influencing factors for sepsis. Conclusion Fever and respiratory symptoms were the main symptoms of influenza in elderly patients,and the body temperature was significantly decreased after48 h of Oseltamivir Phosphate treatment. Patients with coronary heart disease,COPD and wheezing symptoms were independent influencing factors for sepsis.
作者
钟雪锋
李毅
方保民
李燕明
柯会星
孙铁英
ZHONG Xue-feng;LI Yi;FANG Bao-min;LI Yan-ming;KE Hui-xing;SUN Tie-ying(Graduate School of Peking Union Medical College,Beijing 100730,China;Department of Pulmonary and Critical Care Medicine,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)
出处
《临床药物治疗杂志》
2021年第6期57-63,共7页
Clinical Medication Journal
基金
基于多元大数据发热呼吸系多重感染病原流行的预测预警模型构建与应用示范(2018ZX10201002-010)。
