急诊社区获得性肺炎患者PaCO_2水平与预后的关系研究
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摘要
目的研究急诊社区获得性肺炎(CAP)患者动脉二氧化碳分压(PaCO_2)水平与预后的关系。方法方便选取该院2016年1月—2017年1月急诊CAP患者227例,根据治疗28 d病情转归分为存活组、死亡组,根据入院时PaCO_2水平高、低、正常分为高水平组、低水平组和正常组,收集患者临床症状、体征、影像等资料,采用单因素和Pearson相关性分析其相关性。结果 (1)死亡组高PaCO_2水平和低PaCO_2水平患者的构成比例分别为16.84%、38.78%高于存活组的25.81%、61.29%,使用呼吸机患者构成比例为67.74%,高于存活组的9.69%,合并COPD患者占29.03%,多于存活组的5.61%(P<0.05)。(2)根据PaCO_2水平分组,低水平组、高水平组PaO_2<60 mm Hg患者构成比例分别为16.84%、53.66%,均高于正常组的3.30%(P<0.05)。低水平组呼吸机使用率、死亡率分别为23.16%、18.95%,高水平组分别为26.83%、21.95%,均高于正常组的7.69%、4.40%(P<0.05)。(3)相关性分析显示,高PaCO_2水平与预后呈负相关(r=-0.767,P=0.011),低PaCO_2水平与预后呈正相关(r=0.614,P=0.019),结论 PaCO_2水平与急诊CAP患者预后相关,是患者死亡的危险因素之一,及早控制PaCO_2水平波动可能对改善预后有帮助。
Objective To research the correlation between the PaCO_2 level and prognosis of patients with emergency community acquired pneumonia. Methods 227 cases of emergency CAP patients in our hospital from January 2016 to January2017 were convenient selected and divided into the survival group and the death group according to the 28 d disease outcome and PaCO_2 level at admission, and the clinical symptoms, vital signs and imaging data were collected and the correlation was analyzed by the single-factor and Pearson analysis. Results The ratio of high PaCO_2 level and low PaCO_2 level in the death group was higher than that in the survival group(16.84% 、38.78% vs 25.81%,61.29%),The death group had a higher propertion of the patients with the breathing machine than the survival group(67.74% vs 9.69%), and the patients with COPD was more than that in the survival group(29.03% vs 5.61%)(P<0.05), and the ratio of patients whose PaO_2< 60 mm Hg in the low-level group and high-level group was higher than that in the normal group(16.84%,53.66% vs 3.30%)(P<0.05), and the respirator use rate and death rate in the low-level group and in the high-level group were higher than those in the normal group(23.16%,18.95%,26.83%,21.95% vs 7.69%,4.40%)(P<0.05), and the correlation analysis showed that the high PaCO_2 level had a negative correlation with the prognosis(r=-0.767, P=0.011), and the low PaCO_2 level had a positive correlation with the prognosis,(r=0.614,P=0.019). Conclusion The PaCO_2 level is correlated with the prognosis of emergency CAP patients, which is one of the risk factors of death, and the early control of PaCO_2 level fluctuation may be help to improve the prognosis.
Objective To research the correlation between the PaCO_2 level and prognosis of patients with emergency community acquired pneumonia. Methods 227 cases of emergency CAP patients in our hospital from January 2016 to January2017 were convenient selected and divided into the survival group and the death group according to the 28 d disease outcome and PaCO_2 level at admission, and the clinical symptoms, vital signs and imaging data were collected and the correlation was analyzed by the single-factor and Pearson analysis. Results The ratio of high PaCO_2 level and low PaCO_2 level in the death group was higher than that in the survival group(16.84% 、38.78% vs 25.81%,61.29%),The death group had a higher propertion of the patients with the breathing machine than the survival group(67.74% vs 9.69%), and the patients with COPD was more than that in the survival group(29.03% vs 5.61%)(P<0.05), and the ratio of patients whose PaO_2< 60 mm Hg in the low-level group and high-level group was higher than that in the normal group(16.84%,53.66% vs 3.30%)(P<0.05), and the respirator use rate and death rate in the low-level group and in the high-level group were higher than those in the normal group(23.16%,18.95%,26.83%,21.95% vs 7.69%,4.40%)(P<0.05), and the correlation analysis showed that the high PaCO_2 level had a negative correlation with the prognosis(r=-0.767, P=0.011), and the low PaCO_2 level had a positive correlation with the prognosis,(r=0.614,P=0.019). Conclusion The PaCO_2 level is correlated with the prognosis of emergency CAP patients, which is one of the risk factors of death, and the early control of PaCO_2 level fluctuation may be help to improve the prognosis.
引文
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[9]莫新,唐皓,曾丽金,等.血清胆碱酯酶含量对重症肺炎患者病情和预后的评估价值[J].中华危重病急救医学,2016(1):38-43.
[10]刘晓伟,李璐璐,刘志,等.机械通气前PaCO2水平预测支气管哮喘患者预后的研究[J].中华全科医师杂志,2014,13(8):668-671.
[2]张婉丽,曹同瓦.生物学指标预测社区获得性肺炎患者预后的作用[J].中国感染与化疗杂志,2016,16(5):655-661.
[3]马文通,张泓.CURB-65评分和强化CURB评分对老年重症社区获得性肺炎预测价值的临床研究[J].中国急救医学,2016,36(3):238-241.
[4]谢甜,黄奕江.降钙素原对社区获得性肺炎的鉴别诊断及预后判断价值[J].中华医院感染学杂志,2014,24(4):1030-1032.
[5]杨倩.血乳酸、降钙素原、C反应蛋白在老年社区获得性肺炎患者中的变化及临床意义[J].中国医学前沿杂志:电子版,2016,3(8):56-59.
[6]吴雷琪,米娜瓦尔·胡加,武云,等.影响老年重症社区获得性肺炎预后危险因素的回顾性分析[J].中国现代医学杂志,2013,23(4):75-78.
[7]龙威,黄高忠,李利娟,等.D-二聚体对社区获得性肺炎病情及长期预后的判断[J].中华急诊医学杂志,2015,24(1):77-80.
[8]陈云霞,李春盛.肾上腺髓质素对急诊社区获得性肺炎患者的预后和危险分层价值[J].中华危重病急救医学,2014,26(2):115-119.
[9]莫新,唐皓,曾丽金,等.血清胆碱酯酶含量对重症肺炎患者病情和预后的评估价值[J].中华危重病急救医学,2016(1):38-43.
[10]刘晓伟,李璐璐,刘志,等.机械通气前PaCO2水平预测支气管哮喘患者预后的研究[J].中华全科医师杂志,2014,13(8):668-671.