摘要目的 探讨老年重症肺炎病死率的危险因素,以提高临床的救治率.方法 参照2001年美国胸科学会(ATS)指南对重症肺炎的诊断标准,分析54例重症肺炎患者的临床资料,其中经验性抗菌治疗按指南推荐方案治疗组36例,未按指南推荐方案治疗组18例.结果 54例重症肺炎病死率为66.67%(36/54),死亡患者的平均年龄为(79±4)岁,高于生存者(70±5)岁的平均年龄,P<0.05.按指南推荐方案治疗组和未按指南推荐方案治疗组的病死率分别为55.56%(20/36)和88.89%(16/18);36例并有1～2个脏器功能衰竭和18例有三个以上脏器功能衰竭患者的病死率分别为55.56%(20/36)和88.89%(16/18),P<0.05.患有一种以上的基础疾病96.30%(52/54),免疫功能低下70.37%(38/54),血浆白蛋白降低77.78%(42/54),P<0.01.结论 高龄、多脏器功能衰竭、伴有多种基础疾病、免疫功能低下及血浆白蛋白降低等是重症肺炎病死率的主要影响因素,选择按指南推荐方案治疗可降低重症肺炎病死率.

abstractsObjective To investigate the risk factors associated with the mortality of severe pneumonia for improving its salvage rate in clinical practice. Methods According to guidelines of ATS 2001 for the man-agement of adults with severe pneumonia, fifty-four patients with severe pneumonia were recruited and divided into two groups:36 patients treated according to the ATS guidelines and 18 ones treated with escalation antibiot-ics therapy. Results The mortality was 66.67% (36/54) for all 54 patients with severe pneumonia, and the mortalities of the 36 patients with one or two organs function failures and the 18 ones with three and more organs function failures were 55.56% (20/36) and 88.89% (16/18),respectively,P<0.05. The mean age (79±4 years) of the 36 died patients was older than that (70±5 years) of the 18 survivors (P<0.05). The mortality of the ATS guidelines treatment group was 55.56% (20/36), which was significantly lower than 88. 89% (16/18)of the escalation antibiotics therapy (P<0.05). The morbidities of more than one underlying diseases, im-munecompromise and the decrease of albumin were 70.37% (38/54) and 77.78% (42/54),P<0.01,respec-tively. Conclusion Elderly,multiple organs function failures,immunecompromise and the decrease of albumin were main risky factors related with the mortality of severe pneumonia;Treatment according to the ATS guide-lines may reduce the mortality.