Prognosis And Treatment Of Severe Community Acquired Pneumonia In Elderly Patients With Respiratory Support Technology

Objective: Review invasive mechanical ventilation and conventional treatment(mask ventilation)in the two groups of clinical indicators,to evaluation respiratory therapy and prognostic factors of the severe pneumonia in elderly.Methods: The object of study were in elderly patients with severe community-acquired pneumonia form January 2013 to October 2016 in the first affiliated hospital of Da Lian Medical university,totally 85 cases,including 58 cases in treatment group of invasive mechanical ventilation,noninvasive breathing treatment group for 2 cases,conventional treatment group of 25 patients,all patients accept anti-infection therapy,expectorant,smooth wheezing,to maintain electrolyte balance and acid-base balance,nutritional support and other conventional treatment;All the patients age should be 65 or higher and must be in accordance with the standard of diagnosis of severe CAP standards(IDSA/ATS).We collect all the patient’s general information(basic characteristics,basic diseases and complications)、total MV time of the normal ventilation and mechanical ventilation、the incidence of VAP、the time of ETI and the results of blood gas analysis before and after therapy(7 days)、liver and kidney function,electrolyte,blood routine,the basic information,such as X-ray or CT;To Compare the treatment of blood gas、 hospitalization time、hospital stay、mortality、curb-65、curb-age、 MDR and fungal infection before and after form two groups of patients.Using bivariate correlation analysis the correlation of complications and adverse reactions associated with mortality;Using bivariate and multivariate logistic regression analysis and predict the risk factors of death;Kaplan-Meier survival curve analysis severe case fatality rate in elderly CAP patients.Results: The baseline data and clinical characteristics of two groups of patients(gender,age,diabetes,COPD,with basic diseases such as cardiovascular disease and chronic kidney disease and most experimental indicators)had no statistical significance after contrast differences(P>0.05).In each group analysis of differences between before and after the treatment,the pH,PaCO2、WBC of two treatment group has significant differences before and after the treatment(P<0.05),both pH 、PaCO2、WBC in after treatment was better,the other indicators before and after treatment had no significant difference(P>0.05).Comparison between the two groups,the treatment of invasive ventilation treatment before the pH value is significantly lower than the conventional ventilation treatment group(P<0.05),the proportion of patients with cerebrovascular diseases significantly lower than conventional ventilation group(P<0.001),BUN、 Curb-age、MDR、fatality rate is significantly higher than in conventional ventilation treatment group(P=0.019,0.018,0.001,0.018< 0.05).The judgment of basis relationship between base disease、adverse reactions and disease outcome is which BUN、Curb-65、Curb-age、the time of ETI,the Curb-age≥3、Curb-age≥4,Curb-65≥3 show significant correlation with mortality of the eldly patients with severe CAP(P<0.01 or<0.05).Binary logistic show cardiovascular disease(P=0.036)、Curb-age(P=0.041),the number of underlying diseases≥3(P=0.023)、ETI≥3(P=0.039)and Curb-age≥3(P=0.027)had significant differences(P<0.05).Multinomial logistic show cardiovascular disease(P=0.033)、the number of underlying diseases≥3(P=0.002)and Curb-age≥3(P=0.007)had significant correlation(P< 0.05).Kaplan-Meier survival curve analysis showed that the number of underlying diseases≥3(χ2= 4.989,P= 0.026<0.05)and Curb-age≥3(χ2= 5.460,P = 0.019<0.05)were associated with the fatality rate in elderly patients with severe CAP significantly.Conclusion:(1)In this sample analysis of two groups of treatment of the elderly severe CAP are better;Invasive mechanical ventilation did not improve survival rates,but the routine therapy can never replace invasive mechanical ventilation therapy.(2)The relationship between basic diseases 、 adverse reactions and disease outcomes show that BUN、 Curb-65、Curb-age、the time of ETI and fatality rate have significantly positive correlation in elderly severe CAP patients.(3)The number of underlying diseases≥3and Curb-age≥3 had significant correlation with the increased mortality.