收稿日期: 2025-01-03
网络出版日期: 2025-05-21
基金资助
2022年度安徽省转化医学研究院科研课题基金项目(2022zhyx-C26)
Effects of glucocorticoid on APACHE Ⅱ， SOFA scores and prognosis of elderly patients with severe pneumonia and respiratory failure
Received date: 2025-01-03
Online published: 2025-05-21
目的 探讨糖皮质激素用于治疗老年重症肺炎（SP）合并呼吸衰竭（RF）患者的应用价值。 方法 回顾性分析医院2022年1月至2023年12月住院治疗的208例老年SP合并RF患者的临床资料，根据是否应用糖皮质激素分为非激素组（n = 83）及激素组（n = 125）。采用倾向性评分匹配法对两组患者进行1∶1匹配，得到每组71例患者。比较两组临床指标、病情改善情况、血气指标、实验室生化指标及预后。 结果 激素组呼吸机使用时间及住院时间短于非激素组（P < 0.05）；治疗7 d后，激素组格拉斯哥昏迷（GCS）评分、氧合指数（P/F）、血氧饱和度（SaO2）、淋巴细胞计数（TLC）高于非激素组，急性生理与慢性健康评分（APACHE Ⅱ）、序贯器官衰竭评估（SOFA）评分、二氧化碳分压（PaCO2）、血乳酸（LAC）、降钙素原（PCT）低于非激素组（P < 0.05）；生存曲线显示，激素组28 d生存率高于非激素组（P < 0.05）；Cox比例风险模型显示，未使用糖皮质激素为老年SP合并RF患者28 d病死的独立危险因素（P < 0.05）。 结论 应用糖皮质激素治疗老年SP合并RF能够缩短呼吸机使用时间及住院时间，缓解患者病情，促进血气指标恢复，改善生化指标，提高患者生存率。
杨奎 , 潘旭冉 , 邵敏 . 糖皮质激素治疗老年重症肺炎合并呼吸衰竭患者对APACHEⅡ、SOFA评分及预后的影响[J]. 实用医学杂志, 2025 , 41(10) : 1569 -1574 . DOI: 10.3969/j.issn.1006-5725.2025.10.020
Objective To explore the application value of glucocorticoid in the treatment of elderly patients with severe pneumonia （SP） and respiratory failure （RF）. Methods A retrospective analysis was performed on the clinical data of 208 elderly patients with SP and RF in the hospital between January 2022 and December 2023. According to use of glucocorticoid or not， patients were divided into non-hormone group （n = 83） and hormone group （n = 125）. According to propensity score matching method， there were 71 patients in each group. The clinical indexes， disease improvement， blood gas indexes， laboratory biochemical indexes and prognosis were compared between the two groups. Results The ventilator use time and length of hospital stay in hormone group were shorter than those in non-hormone group （P < 0.05）. After 7 d of treatment， score of Glasgow coma scale （GCS）， oxygenation index （P/F）， blood oxygen saturation （SaO2） and lymphocyte count （TLC） in hormone group were higher than those in non-hormone group， while scores of acute physiological and chronic health evaluation Ⅱ （APACHE Ⅱ） and sequential organ failure assessment （SOFA）， partial pressure of carbon dioxide （PaCO2）， blood lactic acid （LAC） and procalcitonin （PCT） were lower than those in non-hormone group （P < 0.05）. The survival curves showed that 28 d survival rate in hormone group was higher than that in non-hormone group （P < 0.05）. Cox proportional hazard model showed that no use of glucocorticoids was an independent risk factor of 28d death in elderly patients with SP and RF （P < 0.05）. Conclusion Glucocorticoid can shorten ventilator use time and length of hospital stay， alleviate disease severity， promote the recovery of blood gas indexes， improve biochemical indexes and increase survival rate in elderly patients with SP and RF.
Key words： severe pneumonia; glucocorticoid; elderly; respiratory failure; prognosis
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