CAJ | 학술논문

目的探讨老年肺炎合并感染性休克患者预后相关因素。方法分析88例老年肺炎合并感染性休克患者的临床资料，用单因素分析比较不同预后组患者预后可能相关因素，再将有统计学差异的因素用多因素回归分析筛选出与死亡相关的独立危险因素。结果老年肺炎合并感染性休克患者病死率56.8％，单因素分析结果提示死亡组年龄、APACHEⅡ评分、功能不全脏器的数量、干预前及治疗6 h后血乳酸水平均显著高于存活组（均P＜0.05），且神经、凝血、肾功能不全的发生率均高于存活组（均P＜0.05），多因素Logistic分析提示入ICU时APACHEⅡ评分≥26.5分、治疗6 h后血乳酸水平≥4.0 mmol/L、器官衰竭数量≥3.6个、神经功能不全为不良预后的独立危险因素。结论老年肺炎患者一旦合并感染性休克病死率就会高，其治疗前病情危重程度、早期干预后血乳酸水平、脏器功能不全的数量（尤其是脑）与预后密切相关，因此如何尽早干预以降低血乳酸水平、避免脏器功能受损对患者预后有极其重要的意义。
목적탐토노년폐염합병감염성휴극환자예후상관인소。방법분석88례노년폐염합병감염성휴극환자적림상자료，용단인소분석비교불동예후조환자예후가능상관인소，재장유통계학차이적인소용다인소회귀분석사선출여사망상관적독립위험인소。결과노년폐염합병감염성휴극환자병사솔56.8％，단인소분석결과제시사망조년령、APACHEⅡ평분、공능불전장기적수량、간예전급치료6 h후혈유산수평균현저고우존활조（균P＜0.05），차신경、응혈、신공능불전적발생솔균고우존활조（균P＜0.05），다인소Logistic분석제시입ICU시APACHEⅡ평분≥26.5분、치료6 h후혈유산수평≥4.0 mmol/L、기관쇠갈수량≥3.6개、신경공능불전위불량예후적독립위험인소。결론노년폐염환자일단합병감염성휴극병사솔취회고，기치료전병정위중정도、조기간예후혈유산수평、장기공능불전적수량（우기시뇌）여예후밀절상관，인차여하진조간예이강저혈유산수평、피면장기공능수손대환자예후유겁기중요적의의。
Objective To investigate the prognostic related factor of elderly pneumonia complicated with septic shock.Methods The clinical data of admitted 88 elder patients with pneumonia complicated with septic shock were analyzed ,and the patients were grouped to survival group and death group .The possible prognostic related factors were compared between groups used signal factors analysis , and the independent risk factors of death were secondary analyzed used multinomial logistic regression .Results The mobility of elderly pneumonia complicated with septic shock patients was 56.8%.The age,APACHEⅡscore,the number of dysfunctional organs ,and the serum lactate levels before and 6 h after intervention in the death group were higher than those in survival group ( all P<0.05 ) .And the incident rate of renal dysfunction ,coagulation dysfunction or encephalitic dysfunction was also higher in the death group than that in the survival group respectively .Further multinomial analysis illustrated that the APACHEⅡscore≥26.5 ,the serum lactate concentration≥4.0 mmol/L 6 h after intervention ,the numbers of failure organs≥3.6 and encephalitic failure were three independent death-related risk factors .Conclusions The mortality of elderly pneumonia complicated with septic shock was high ,and it was closely related with illness severity before intervention , serum lactate level after early stage intervention and numbers of dysfunction organs ( especially the brain).Hence,it is keys to lowering the serum lactate level as soon as possible and prevent the organic function insult in the surviving elderly pneumonia complicated with shock .