| Part 1:Clinical analysis of mechanical ventilation in elderly patients with severe CAP measurement data conforming to normal distribution.Chi-square test and Fisher's exact probability method(F<5);Multivariate analysis was performed using binary logistic regression.analysis.Survival data were analyzed by-Kaplan-Meier.When the results were counted,When P<0.05,the difference was statistically significant.Results:Compared with the MV group,there was no statistical significance in the mortality of hospitalization between the two groups for the main outcome indicators,the value of which was 61.1%vs 72%,P=0.329.There was no signifi cant difference in the fatality rate at 28 days of hospitalization(48.6%vs 48%,P=0.958).The GCS score of the NIV group was obviously higher than that of IMV group,and at the APACHE ? score,SOFA score of IMV group were significantly higher than the NIV group.Stratified analysis found that when the APACHE ? scoring ?36.8 points,SOFA?6 points and GCS<13 points were no statistically significant differences in hospital mortality between the NIV and IMV group.The hospital time,the RICU time and the cost of hospitalization in the NIV group were significantly lower than those in the IMV group(P=0.044,P=0.045,P=0.014,respectively).The proportion of severe immunosuppression,the proportion of using glucocorticoid therapy,systolic blood pressure and diastolic blood pressure,blood Hb,PLT,serum albumin of NIV group were significantly higher than these of IMV group,while the proportion of Alzheimer's disease,the proportion of coma,creatinine and urea,the levels of serum sodium and serum chloride,the proportion of sepsis shock,HAP rate of IMV group were significantly higher than the NIV group.The fatality rate of conversion to IMV after NIV failure was 87.1%.The P/F value of the NIV+IMV group was significantly lower than that of the NIV+IMV group,but there was no significant difference in clinical scores,basic diseases,clinical symptoms and signs,and the assessment of vital organ functions at the time of enrollment.Analysis of risk factors for failure of NIV found that the proportion of no P/F improvement within 24 hours of NIV use was signifiantly higher in the NIV failure group than in the NIV success group,and the proportion of HFNC used at beginning after hospitalized and before enrollment was significantly higher in the NIV success group than in the NIV failure group.Urea>16.6 umol/L,TNI>0.26 ng/ml.ACS,gastrointestinal bleeding,? type of respiratory failure,ARDS,septic shock were independent risk factors for the failure of NIV.the P values were 0.025,0.005,0.004,0.025,0.006,0.032,0.009 respectively.Conclusions:Severe pneumonia complicated with acute respiratory failure should be treated with mechanical ventilation as soon as possible.Both NIV and IMV can be used as an initial choice of respiratory support therapy for the elderly SCAP patients with P/F<150mmHg.Failure of NIV have the highest mortality rate.Urea>16.6 umol/L,TNI>0.26 ng/ml,ACS,gastrointestinal bleeding,? type of respiratory failure,ARDS,septic shock were independent risk factors for the failure of NIV.Objective:To investigate the therapeutic value of NIV in the treatment of elderly severe community-acquired pneumonia with oxygenation index less than 150mmHg.Methods:A retrospective case-control study was conducted to include old patients with severe pneumonia with oxygenation index less than 150mmHg admitted to Beijing Hospital RICU from May 1,2011 to December 31,2020.According to the admission and exclusion criteria,72 patients treated with NIV were included in the NIV group,and 25 patients treated with IMV were included in the IMV group.Clinical and laboratory data of the patients were collected and analyzed.In order to find out whether there was a difference in the results caused by the selection bias of initial respiratory support after enrollment,NIV-only group(41 cases),NIV+IMV group(31 cases),and the IMV(25 cases)group were compared.Finally,we divided the NIV group into the NIV successful group(24 cases)and the NIV failure group(48 cases including the deaths in the NIV group and the cases converted to IMV),and compared them to find the risk factors for the failure of the NIV.Endpoints:hospitalization fatality rate,28-day hospitalization fatality rate,length of hospital stay,RICU time,time without mecchanical ventilation,hospitalization cost.and risk factors for NIV failure.SPSS 21.0 software was used for statistical analysis.In comparison between the two groups,t test or ANOVA one-way analysis of variance were used for statistical analysis of measurement data conforming to normal distribution,and non-parametric test(Mann-Whitney child test or Kruskai-Wallis H test)was used forPart 2:Analysis of clinical features of influenza in the elderlyObjective To investigate the clinical features of influenza in the elderly.Methods Clinical and laboratory data of elderly patients with influenza A and Influenza B confirmed in the geriatric ward of Beijing Hospital from October 2017 to March 2018 were collected.Describe the overall clinical characteristics of influenza in elderly patients,and compare the long-lived patients(age?90 years)and the common elderly(60 years ?age<90 years)differences in clinical features of influenza.SPSS 16.0 software was used for statistics,and?2 test was used for counting data.Measurement data are t-tested.When P<0.05,the difference was confirmed statistically significant.Results From October 2017 to March 2018,a total of 47 patients with influenza were confirmed in the geriatric ward of Beijing Hospital,of whom 20 were aged?90 years old,accounting for 42.5%.Over all clinical features:the average age was 86.47±11.62 years old,and nearly 50%of the patients were complicated with cardiovascular and cerebrovascular diseases and COPD.91.5%of the patients had fever,and the highest average body temperature was 38.34±0.75?,which has mainly medium and low fever.The proportion of coughing and expectorating sputum was 74.5%and 66.0%,respectively.The mean PO2/FIO2 ratio was 283.94±65.93 mmHg.The proportion of patients with Sepsis at the time influenza diagnosed was 36.2%,and 29.4%of patients with Sepsis were not consistent with systemic inflammatory response syndrome(SIRS).After oseltamivir treatment,the mean body temperature decreased significantly(38.34±0.75 ? vs 37.34±0.77 ?,t=5.732,P=0.000)on the second day,and the mean body temperature decreased to normal(36.96±0.62 ?)on the third day.The total effective rate of treatment accounted for 97.9%,and the case fatality rate was 2.1%.There were statistically significant differences in average age(96.95±3.53 years vs 78.70±9.09 years,P=0.000),hospitalization rate(100%vs 74.1%,P=0.015)and support rate for requiring non-invasive ventilation(25%vs 3.7%,P=0.041)between the group with?90 years of age and the control group.However,there were no statistically significant differences in major clinical symptoms,laboratory tests,comorbid diseases or treatment efficacy,but the group with?90 years with higher sepsis ratio(50%vs 25.9%,P=0.187)and lower day 7 cure rate(50.0%vs 80.8%,P=0.138).By grouping comparison,there were statistically significant differences in PO2(78.03±18.13mmHg vs 63.45±7.37mmHg,t=2.428,P=0.034)between patients with influenza A and influenza B.Such factors,age>80 years old(94.1%vs 60%,P=0.017),coronary heart disease(64.7%vs 33.3%,?2=4.321,P=0.038),chronic cardiac insufficiency(52.9%vs 10%,P=0.004),chronic obstructive pulmonary disease(COPD)(64.7%vs 33.3%,?2=4.321,P=0.038),SIRS(70.6%vs 40%,?2=4.063,P=0.044),wheezing(47.1%vs 6.7%,P=0.02),respiratory frequency>20 times/min(70.6%vs 26.7%,?2=8.563,P=0.003),had significantly different between sepsis and non-sepsis group.Multivariate Logistic regression analysis showed that coronary heart disease(?=3.924,P=0.016),COPD(?=3.232,P=0.034,)and wheezing symptoms(?=6.158,P=0.010)were independent risk factors for sepsis.Conclusion Influenza in elderly patients is usually characterized by moderate to low fever,mainly with respiratory symptoms,and obvious hypoxemia at the early stage of the disease.Senior citizens aged?90 years have a higher hospitalization rate,with a proportion of up to 50%meeting the sepsis diagnosis and requiring more non-invasive ventilator support treatment.The body temperature was significantly decreased after 48h of oseltamivir phosphate treatment.Patients with coronary heart disease,COPD and wheezing symptoms were independent risk factors for sepsis. |
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