Analysis Of Diagnosis And Treatment Experienceand Risk Factors Of 101cases Of Community-acquired Pneumonia In Elderly Patients With Bedridden

Objective:To deeply investigate the clinical and pathogens characteristics,and treatment experience of community acquired pneumonia in the elderly patients with bedridden.Exploring the related risk factors that affect the prognosis of CAP in the bedridden elderly and optimizing diagnosis and treatment plan,to provide reference for further improving the prognosis and reducing the case fatality rate,so as to promote the early correct diagnosis and treatment of pneumonia in the elderly,and to strive for the best therapeutic effect,shorten the length of hospital stay and reduce the cost of medical treatment.Methods:1.The clinical data of community acquired pneumonia(CAP)wereanalyzed retrospectively in elderly patients of department of geriatrics of third Class A Hospital from December,2015 to December,2016.2.The observed indexes include the reasons for staying in bedridden,the condition of basic disease,the relationship between inducement and climate change,the main clinical manifestation,laboratory examination,pathogenic bacteria and drug resistance,blood gas analysis,pleural fluid condition,imaging features of lungand complications,etc.3.The treatment process,treatment results and complications of the elderly pneumonia patients who were in bedridden were retrospectively summarized and recorded.The research data was arranged by Excel table,which was analyzed and processed by SPSS22.0 software.To all possible risk factors(35 Items),single factor analysis was carried out,to screen out the risk factors that had significant influence on death.Using counting data(Percentage)to represent the enumeration data,and the ratio between the two groups was measured by chi-square test,when P<0.05,the difference was statistically significant.The enumeration data were expressed in normal distribution with the mean plus/minus the standard deviation,and two independent sample t tests were used for comparison between the two groups.Non-parametric test was used to compare the cumulative number of diseases in the group(Mann-Whitney U test).Logistic multivariate regression analysis was carried out to analyze the significant difference factors in single factor,to further filter out the independent risk factors related to CAP of the elderly in bed,and calculate the OR value and CI,andwhen P<0.05,the difference were statistically significant.Results:1.bedridden reasonSequela of cerebrovascular disease 41.58%,fracture11.88%,asthenia 34.65%,brain atrophy 9.90%and others 1.98%.2.Incentives and climate change1)Incentives 66.34%were mistaken and 40.59%had the cause of upper respiratory tract infection.2)48.51%sickin winter;43.56%in spring,5.94%in autumn and1.98%in summer.3.Results of single factor analysisshowed that:By two independent samples t test,the death group compared with the survival group,shows that age has significant influence on survival and death.(T=-5.364,P<0.001).By chi-square test,cardiovascular disease,tumor,COPD,consciousness change,nervous system disease,leukocyte>10×10~9/L,hemoglobin reduction,site,pleural effusion,respiratory failure,heart failure,renal failure,upper gastrointestinal hemorrhage,shock,multiple organ failure and mechanical ventilation had significant effects on survival and death.(P<0.05);Sex,smoke,cough and sputum,asthma,lung rale,diabetes,other diseases,fever,shivering,dyspnea,digestivetract symptoms or anorexia,arrhythmia,leukocyte<4×10~9/L,neutrophil>75%,D two polymer increase,CRP increase,albumin>0.05).By the nonparametric test(Mann-Whitney U test),the cumulative number of diseases has a significant effect on survival and death(Z=-3.961,P<0.001).4.The results of multivariate analysis showed that:The results of logistic multivariate regression analysis showed that multiple organ failure(OR=21.949,P=0.019),renal failure(OR=49.700,P=0.002),shock(OR=91.435,P=0.001),mechanical ventilation(OR=16.737,P=0.034),multiple organ failure,renal failure,shock and mechanical ventilation as above are independent risk factors for death.(P<0.05).Conclusions:The clinical features of community-acquired pneumonia(CAP)in the elderly bedridden mainly include a variety of underlying diseases accompany and the clinical manifestations not typical.The pathogenic bacteria were mainly gram-negative bacilli.Multiple factors as cardiovascular disease,tumor,COPD,consciousness change,nervous system disease,leukocyte>10×10~9/L,hemoglobin reduction,site,pleural effusion,respiratory failure,heart failure,renal failure,upper gastrointestinal hemorrhage,shock,multiple organ failure and mechanical ventilation had significant effects on survival and death.(P<0.05);Multiple organ failure,renal failure,shock,mechanical ventilation will have a negative impact on the prognosis,in clinical work,we should pay attention to relevant risk factors,and focus on the observation of death related indicators.After active treatment,the prognosis of this pneumonia is still poor,with many complications and high mortality rate.