陈知+江桂忠+郭劼琳

[摘要] 目的 探討低磷血症对老年社区获得性肺炎（CAP）患者近期预后的影响。 方法 选取2013年1月～2014年8月惠州仲恺高新区人民医院收治112例老年CAP患者为研究对象，根据是否伴有低磷血症分为两组，其中，低磷血症组42例，非低磷血症组70例。检测患者入院24 h内的血气分析、血常规等实验室检查指标，并记录两组患者平均住院时间、抗感染治疗时间、死亡率、肺炎严重程度等指标，进行统计学比较分析。 结果 低磷血症组患者血钠、白蛋白、PaO2水平均明显低于非低磷血症组患者，差异有统计学意义（P < 0.05）；而CRP水平、WBC计数均明显高于非低磷血症组患者，差异有统计学意义（P < 0.05）；低磷血症组平均住院时间、抗感染治疗时间、APACHEⅡ评分、死亡率、重症肺炎发生率均明显高于非低磷血症组，差异均有统计学意义（均P < 0.05）。 结论 血磷水平与老年CAP患者预后密切相关。

[关键词] 低磷血症；老年；社区获得性肺炎；近期预后；相关性

[中图分类号] R563.1 [文献标识码] A [文章编号] 1673-7210（2017）07（b）-0125-04

Influence of hypophosphatemia on the short-term prognosis of elderly patients with community-acquired pneumonia

CHEN Zhi1 JIANG Guizhong2 GUO Jielin3

1.Department of Emergency， Huizhou First People's Hospital， Guangdong Province， Huizhou 516023， China； 2.Chronic Disease Prevention and Control Station of Boluo County in Huizhou City， Guangdong Province， Boluo 516023， China； 3.Chronic Disease Prevention and Control Station of Huicheng District in Huizhou City， Guangdong Province， Huizhou 516023， China

[Abstract] Objective To investigate the influence of hypophosphatemia on the short-term prognosis of elderly patients with community-acquired pneumonia （CAP）. Methods A total of 112 elderly patients with CAP treated in People's Hospital of Huizhou Zhongkai Hi-tech Industrial Development Zone from January 2013 to August 2014 were selected. According to whether combined with hypophosphatemia or not， patients were divided into hypophosphatemia group （n=42） and non-hypophosphatemia group （n=70）. The indexes of laboratory examination， including blood gas analysis， blood routine examination were detected within 24 hours of hospitalization. The average hospital stay， time of anti-infection treatment， the mortality rate and the severity of pneumonia were recorded. All the data were analyzed statistically. Results The levels of serum sodium， albumin and PaO2 in patients of the hypophosphatemia group were significantly lower than those of the non-hypophosphatemia group （P < 0.05）， while CRP level and WBC were significantly higher than those of the non-hypophosphatemia group （P < 0.05）. The average hospital stay， time of anti-infection treatment， APACHEⅡ score， mortality rate and severity of severe pneumonia in the patients of the hypophosphatemia group were significantly higher than those of the non-hypophosphatemia group （P < 0.05）. Conclusion The level of serum phosphorus is closely related to the prognosis of elderly patients with CAP.

[Key words] Hypophosphatemia； Old age； Community acquired pneumonia； Short-term prognosis； Correlation

社区获得性肺炎（CAP）目前仍是对人类健康构成威胁的常见感染性疾病之一，在全球范围内发病率和死亡率均高，老年CAP同样具有高发病率及高死亡率的特点[1-5]。CAP是临床上的常见病与多发病，在老年患者中，因免疫能力与全身反应性降低，缺乏特异性临床症状。有研究认为，快速准确地评估CAP病情，分层诊治，可降低病死率[6-8]。对CAP患者病情预后快速准确地进行评估并决定分层诊治一直是急诊科医师面临的挑战之一。低磷血症是一种常见的电解质紊乱疾病，其临床表现无特异性，故容易被忽略[9]。低磷血症可引起如厌食、头晕、肌无力等神经肌肉症状，病情严重者可发生昏迷、神经紊乱、抽搐甚至死亡。国外研究提示，低磷血症与老年CAP患者住院死亡率及复杂重症患者比例间存在相关性[10]，但低磷血症与老年CAP患者预后之间的关系尚未见报道。……