老年人社区获得性肺炎临床治疗与预后分析

摘要

Objective To observe the relationship between clinical medication and the prognosis in elderly community-acquired pneumonia (CAP).Methods A prospective randomized controlled single-blind study in Tianjin Hospital Internal Medicine.A total of 160 elderly patients with CAP were selected from January 2011 and January 2015.According to the computer,patients were randomly divided into treatment group and control group,80 cases in each group.Treatment group adopted routine treatment and moderate amount of glucocorticoids in combination with a low-dose of diuretic,and the control group only received routine treatment.In two groups of patients,we observed the initial treatment effect,change in pulse oxygen saturation,the rate of invasive test,the incidence of adverse reactions,mortality rate,total hospital stay,etc.Results Compared with control group,the initial treatment was better,the improvement rate in SPO2 was increased,and the rate of invasive test was decreased in treatment group 72 hours after treatment (x2 =6.234,3.906 and 7.059,respectively,P=0.013,0.048 and 0.008).After the overall prognosis and outcome analysis,compared with control group,the percentage of patients transferred to the intensive care unit,the mortality rate was decreased (x2=4.783 and 4.737,P=0.029 and 0.030),hospitalization cost was declined,and the total hospital stay was shorted (x2 =-72.087 and-5.127,both P＜0.0001).There was no statistically significant difference in the incidence of adverse reactions such as electrolyte disorder and mental disorder(both P＞0.05).Conclusions Corticosteroids in combination with a low-dose of diuretic for the auxiliary treatment of elderly CAP can reduce the mortality rate,decrease the rate of invasive test,and shorten the duration of hospitalization,with no obvious increase of adverse events,and it help to improve the prognosis of CAP patients.%目的 观察老年人社区获得性肺炎(CAP)临床用药与预后的关系. 方法 采用前瞻性随机对照单盲研究方法,选择2011年1月至2015年1月入住天津市天津医院内科的老年CAP患者160例,按计算机生成数字将患者随机分为治疗组与对照组,每组80例.治疗组采用CAP的常规治疗加上中等量糖皮质激素联合小剂量利尿剂,对照组仅采用CAP的常规治疗.观察两组患者初始治疗效果、脉搏血氧饱和度(SPO2)改善率、有创检查率、不良反应发生率、病死率、总住院日等. 结果 72 h效果评价,治疗组与对照组比较初始治疗效果更好,SPO2改善率增加,有创检查率下降(x2值分别为6.234、3.906、7.059,P值分别为0.013、0.048、0.008);总体预后与转归分析,治疗组与对照组比较转入重症监护室比例下降,病死率下降,住院费用降低,总住院日缩短(x2值分别为4.783、4.737、-72.087、-5.127,P值分别为0.029、0.030、＜0.0001、＜0.0001);电解质紊乱及精神异常等不良反应发生率未见明显增加,差异无统计学意义(均P＞0.05). 结论 糖皮质激素联合小剂量利尿剂用以辅助治疗老年人CAP,可降低病死率,减少有创检查几率,缩短病程,短期使用不良反应事件无明显增加,有助于改善患者预后.