肺部感染并发老年多器官功能不全综合征的临床特征及治疗研究

摘要

Objective To investigate the clinical characteristics and therapeutic effect of multiple organ dys-function syndrome ( Multiple organ dysfunction syndrome in elderly, MODSE) in elderly patients with pulmonary in-fection, in order to better treat the disease. Methods The clinical data of 26 elderly pulmonary infection patients with MODSE were retrospectively analyzed. The changes of clinical features, imaging and laboratory data indicators were observed. Results The main symptom was pulmonary infection complicated with MODSE dyspnea (80. 77%), all with mosist crackles and 80. 77% with cyanosis. Radiographic pneumonia and bilateral pleural effusion were com-monly observed, and leukocytes, neutrophils and C-reactive protein increased (80. 77%, 96. 15%). Hypercapnia accounted for 84. 61%. The most common pathogen was Pseudomonas aeruginosa. 3 cases cured after treatment, 16 cases improved, and 7 cases of death reported. After treatment, their body temperature, respiration, pulse, white blood cells, APACHEⅡscores decreased significantly decreased, and prealbumin and albumin increased significant-ly (t=7. 354, 8. 315, 8. 178, 9. 262, 7. 567, 8. 104, 8. 568, P<0. 05). The mortality was 66. 67% for those with more than 5 underlying diseases, 75% for those with three or more MODSE organ failure, and it reached 100% while antimicrobial agents used unreasonably. The mortality was 57. 14% for those duration of hospital stay more than 14 days. Conclusion The clinical manifestations of lung infection complicated with MODSE are complex. Those with more bacteria, underlying diseases, and affected organs had worse prognosis. The early and rational use of antibiotics and other symptomatic treatment has great value for lung infection complicated MODSE.%目的 探讨肺部感染并发老年多器官功能不全综合征(Multiple organ dysfunction syndromein the elderly,MODSE)临床特征和治疗效果,以期更好治疗该疾病.方法 回顾性分析2013年1月-2016年1月我院收治26例肺部感染后并发老年MODSE患者,对其临床特点、影像和实验室等指标变化情况,观察采用痰热清注射液等治疗后相关指标变化.结果 肺部感染并发MODSE以呼吸困难为首发症状,占80.77%,全部出现湿啰音,体征以紫绀最常见,占80.77%;影像学以双侧肺炎和胸腔积液常见,实验室指标上白细胞均升高,中性粒细胞和C反应蛋白也较高,占80.77%、96.15%,高二氧化碳血症占84.61%;病原菌以铜绿假单胞菌最常见;治疗后治愈3例,好转16例,死亡7例;治疗后在体温、呼吸、脉搏、白细胞、APACHEⅡ评分较治疗前均显著下降,前白蛋白、白蛋白较治疗前显著升高,治疗前后比较差异显著(t=7.354、8.315、8.178、9.262、7.567、8.104、8.568,P均<0.05);其中基础疾病5种以上死亡率66.67%,MODSE器官衰竭在3个以上死亡率75%,抗菌药物不合理死亡率100%,住院时间超过14d的死亡率为57.14%.结论 肺部感染并发MODSE临床表现复杂,细菌分布多,基础疾病、受累器官越多,预后越差,早期、合理使用抗菌药物等对症处理后,对肺部感染合并MODSE有重要价值.