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

doi:10.3969/j.issn.1006-5725.2025.10.020

Abstract

Abstract:

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

CLC Number:

R563.1

Kui YANG,Xuran PAN,Min. SHAO. Effects of glucocorticoid on APACHE Ⅱ， SOFA scores and prognosis of elderly patients with severe pneumonia and respiratory failure[J]. The Journal of Practical Medicine, 2025, 41(10): 1569-1574.

Figures/Tables 7

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References 26

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一般资料	匹配前		χ² /t值	P值	匹配后		χ² /t值	P值
一般资料	激素组（n = 125）	非激素组（n = 83）	χ² /t值	P值	激素组（n = 71）	非激素组（n = 71）	χ² /t值	P值
年龄/岁	76.9 ± 8.6	75.2 ± 7.3	1.481	0.140	75.7 ± 7.7	74.5 ± 6.9	0.978	0.330
性别/［例（%）］			4.641	0.031			2.014	0.156
男	72（57.60）	60（72.29）			43（60.56）	51（71.83）
女	53（42.40）	23（27.71）			28（39.44）	20（28.17）
病程/d	4.92 ± 1.06	5.14 ± 1.33			5.11 ± 1.20	5.20 ± 1.37	0.416	0.678
RF类型/［例（%）］			0.386	0.534			1.076	0.300
Ⅰ型	76（60.80）	54（65.06）			41（57.75）	47（66.20）
Ⅱ型	49（39.20）	29（34.94）			30（42.25）	24（33.80）
病原体类型/［例（%）］			0.794	0.851			1.352	0.717
革兰阴性菌	50（40.00）	33（39.76）			29（40.85）	28（39.44）
革兰阳性菌	29（23.20）	17（20.48）			16（22.54）	15（21.13）
肺炎支原体	33（26.40）	26（31.33）			18（25.35）	23（32.39）
病毒	13（10.40）	7（8.43）			8（11.26）	5（7.04）
初始炎症水平
白细胞计数/（×10⁹/L）	16.75 ± 3.49	14.26 ± 3.82	4.851	< 0.001	16.03 ± 3.15	15.48 ± 3.67	0.958	0.340
C反应蛋白/（mg/L）	68.41 ± 7.68	63.09 ± 9.16	4.526	< 0.001	66.94 ± 7.28	65.37 ± 8.42	1.189	0.237
降钙素原/（μg/L）	8.63 ± 2.04	7.82 ± 1.79	2.942	0.004	8.35 ± 1.89	8.01 ± 1.65	1.142	0.255
合并症数量/种	2.21 ± 0.58	2.16 ± 0.54	0.626	0.532	2.17 ± 0.50	2.12 ± 0.52	0.584	0.560
APACHE Ⅱ评分/分	20.72 ± 3.69	21.34 ± 3.85	1.166	0.245	21.45 ± 3.82	22.06 ± 4.13	0.914	0.363

组别	例数	呼吸机使用时间	住院时间
激素组	71	9.91 ± 2.07	14.85 ± 2.89
非激素组	71	12.85 ± 2.93	19.16 ± 3.57
t值		6.905	7.907
P值		< 0.001	< 0.001

组别	例数	GCS评分		APACHE Ⅱ评分		SOFA评分
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
激素组	71	10.81 ± 1.52	13.24 ± 0.88^*	21.45 ± 3.82	11.90 ± 2.47^*	10.76 ± 2.84	3.59 ± 0.84^*
非激素组	71	10.37 ± 1.75	11.93 ± 1.04^*	22.06 ± 4.13	14.14 ± 3.35^*	11.02 ± 3.06	5.61 ± 1.31^*
t值		1.599	8.102	0.914	4.535	0.525	10.938
P值		0.112	< 0.001	0.363	< 0.001	0.601	< 0.001

组别	例数	P/F		PaCO₂/mmHg		SaO₂/%
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
激素组	71	150.49 ± 26.22	274.81 ± 40.37^?	71.23 ± 4.92	42.13 ± 3.58^?	85.72 ± 4.63	93.65 ± 3.21^?
非激素组	71	153.07 ± 23.86	243.95 ± 35.42^?	69.98 ± 5.36	53.62 ± 4.29^?	84.66 ± 4.81	91.02 ± 3.75^?
t值		0.613	4.842	1.448	17.327	1.338	4.489
P值		0.541	< 0.001	0.150	< 0.001	0.183	< 0.001

组别	例数	LAC/（mmol/L）		PCT/（ng/mL）		TLC/（× 10⁹/L）
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
激素组	71	3.21 ± 0.79	1.45 ± 0.40^?	6.63 ± 1.42	1.49 ± 0.38^?	1.32 ± 0.35	2.07 ± 0.51^?
非激素组	71	3.16 ± 0.82	1.91 ± 0.48^?	6.78 ± 1.55	2.26 ± 0.63^?	1.39 ± 0.32	1.78 ± 0.46^?
t值		0.370	6.203	0.601	8.819	1.244	3.558
P值		0.712	< 0.001	0.549	< 0.001	0.216	< 0.001

Effects of glucocorticoid on APACHE Ⅱ， SOFA scores and prognosis of elderly patients with severe pneumonia and respiratory failure

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因素	风险比	95%置信区间	P值
未使用糖皮质激素	1.156	1.036 ~ 1.276	< 0.001
APACHE Ⅱ评分增加	1.002	0.998 ~ 1.006	< 0.001
白细胞计数增加	1.109	1.086 ~ 1.132	< 0.001
C反应蛋白水平升高	1.075	1.029 ~ 1.121	< 0.001

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