目的 探讨90岁以上高龄患者住院期间死亡的影响因素。方法 回顾性分析2015-01至2021-12空军特色医学中心心内科老年病区住院90岁以上的老人228例,其中死亡组48例,对照组180例,比较两组患者基本情况,入院各项生化指标和入院时日常生活活动能力巴氏指数(Barthel index BI),对影响住院死亡的相关因素进行分析。结果 与对照组比较,死亡组贫血、低蛋白血症、心功能不全、感染性疾病、恶性肿瘤患病率高,差异具有统计学意义(P<0.05)。死亡组BI评分[(32.56±23.74) vs (69.72±15.94)]、血红蛋白[(103.21±18.86) vs (119.34±12.56)]、肾小球滤过率[(56.32±21.34)vs(60.53±14.54)]、白蛋白[(35.23±3.65)vs(39.32±4.32)]水平更低,白细胞总数[(8.98±2.45)vs(6.56±2.23)]、B型钠尿肽[(450.51±90.42)vs(356.65±70.33)]水平更高,差异具有统计学意义P<0.05)。Logistic回归分析结果表明,重度失能(OR=5.09,95% CI 2.02~12.76,P=0.001)、贫血(OR=6.08,95%CI 3.18~13.03,P=0.001)、感染(OR=1.24,95% CI 1.05~2.10,P=0.012)和低白蛋白血症(OR=5.43,95%CI 2.54~11.83,P=0.002)为住院高龄患者死亡的危险因素。结论 对高龄住院患者入院后应积极改善营养状态、贫血状态以及日常生活能力,减少感染,对降低高龄患者的病死率有积极意义。
Abstract
Objective To analyze the characteristics of nonagenarian in hospital and investigate the influencing factors associated with the in-hospital mortality. Methods Two hundred and twenty-eight nonagenarian patients admitted in our department from January 2015 to December 2021 were collected. According to their in-hospital outcome the patients were divided into death group (n=48) and survival group (n=180). The general information, results of biochemical indices at admission and Barthel index (BI) were compared between the two groups , and the influencing factors associated with in-hospital mortality were analyzed. Results Compare with the patients in the survival group, those from the death group had higher rations of anemia, hypoalbuminemia, heart failure, infectious disease and cancer, lower BI [(32.56±23.74) vs (69.72±15.94)], decreased levels of hemoglobin [(103.21±18.86) vs (119.34±12.56)], eGFR[(56.32±21.34) vs (60.53±14.54)] and albumin [(35.23±3.65) vs (39.32±4.32)], but larger white blood cell count [(8.98±2.45) vs (6.56±2.23)] and BNP [(450.51±90.42) vs (356.65±70.33)]. The difference had statistically significant. Logistic regression analysis indicated that severe disability (OR=5.09, 95%CI 2.02-12.76, P=0.001), anemia (OR=6.08, 95%CI 3.18-13.03, P=0.001), infection (OR=1.24, 95% CI 1.05-2.10, P=0.012), hypoalbuminemia (OR=5.43, 95%CI 2.54-11.83, P=0.002) were risk factors of in-hospital death. Conclusions The inpatients aged 90 or above should actively improve their ability of daily living after admission, the malnutrition and anemia should be monitored, reducing the rate of infection, which is of positive significance in reducing the mortality in the elderly.
关键词
高龄患者 /
死亡 /
日常生活能力 /
贫血 /
感染
Key words
aged patient /
mortality /
activity of daily living /
anemia /
infection
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