本文選題：老年患者 + 肺部感染��； 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：目的:在全球范圍內(nèi),因感染性疾病死亡的人數(shù)占人類總死亡人數(shù)的30%左右,而老年患者因自身免疫功能下降、多臟器功能衰退、多種慢性基礎(chǔ)疾病等更易發(fā)生感染,發(fā)病率明顯高于年輕人。在感染性疾病中以呼吸道感染為著,且易造成各種不良事件發(fā)生,嚴(yán)重者可死亡。因此如何預(yù)防及更好地控制感染疾病的發(fā)生發(fā)展,改善患者預(yù)后及降低死亡率已成為目前臨床工作的重點(diǎn)。臨床工作中發(fā)現(xiàn),目前因感染住院的老年患者多伴有營(yíng)養(yǎng)不良及免疫功能低下,而營(yíng)養(yǎng)不良、免疫功能低下可延長(zhǎng)感染患者預(yù)后時(shí)間甚至加重原有感染,如此惡性循環(huán),導(dǎo)致患者經(jīng)久不愈,機(jī)體狀態(tài)越來(lái)越差。因此針對(duì)感染性患者如能盡早評(píng)估篩查其存在營(yíng)養(yǎng)不良及免疫功能低下,并給予積極干預(yù)對(duì)患者的預(yù)后、生活質(zhì)量有極為重要的意義。因感染性疾病中以肺部感染發(fā)生比例最高,故本研究專門(mén)調(diào)查肺部感染患者的營(yíng)養(yǎng)狀態(tài)及免疫功能水平,目前已有關(guān)于感染患者營(yíng)養(yǎng)水平的調(diào)查,但對(duì)于感染患者同時(shí)進(jìn)行營(yíng)養(yǎng)狀態(tài)及免疫水平的評(píng)估研究尚有限,尤其老年患者的研究更少,本研究擬通過(guò)對(duì)老年肺部感染住院患者行營(yíng)養(yǎng)及免疫功能方面評(píng)估分析,并調(diào)查臨床中對(duì)老年肺部感染患者存在營(yíng)養(yǎng)不良及免疫功能低下的干預(yù)情況,為優(yōu)化老年肺部感染患者的營(yíng)養(yǎng)及免疫支持治療提供依據(jù)。方法:選取2016年8月-2017年2月在吉林大學(xué)第一醫(yī)院老年干部科診斷肺部感染的老年患者140名,年齡≥60歲(平均年齡84.05±7.46歲),根據(jù)患者年齡分為三組,A組(60-74歲)、B組(75-89歲)和C組(≥90歲),入院后給予營(yíng)養(yǎng)風(fēng)險(xiǎn)及免疫功能的篩查及評(píng)估,并對(duì)體重指數(shù)(Body mass index,BMI)、膽固醇、低密度脂蛋白(low densith lipoprotein,LDL)、尿酸、肌酐、白蛋白、前白蛋白、血紅蛋白、視黃醇蛋白、淋巴細(xì)胞總數(shù)進(jìn)行分析比較,同時(shí)分析肺部感染存在營(yíng)養(yǎng)不良及免疫功能低下的老年患者臨床干預(yù)的比例。數(shù)據(jù)分析結(jié)果應(yīng)用統(tǒng)計(jì)軟件SPSS22.0進(jìn)行統(tǒng)計(jì)學(xué)分析,以P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:本研究納入140例老年患者進(jìn)行營(yíng)養(yǎng)篩查,A組15例,B組99例,C組26例,總營(yíng)養(yǎng)不良發(fā)生率為68.6%(96/140),總免疫低下發(fā)生率為80.7%(113/140),總營(yíng)養(yǎng)不良合并免疫低下發(fā)生率為58.6%(82/140)。其中不同年齡組營(yíng)養(yǎng)不良及免疫功能低下的比例不同,在A組營(yíng)養(yǎng)不良的發(fā)生率、免疫功能低下發(fā)生比率及營(yíng)養(yǎng)不良合并免疫功能低下發(fā)生率依次為40.0%、53.3%、26.7%;在B組依次為66.7%、79.8%、54.5%;在C組依次為92.3%、100%、92.3%。不同年齡組營(yíng)養(yǎng)不良發(fā)生率差異顯著(P0.05),B組營(yíng)養(yǎng)不良發(fā)生率顯著高于A組(P0.05),C組顯著高于A組(P0.01)和B組(P0.05)。不同年齡組免疫低下發(fā)生率差異顯著(P0.05)。B組免疫低下發(fā)生率顯著高于A組(P0.05),C組顯著高于A組(P0.01)和B組(P0.05)。另外,不同年齡組營(yíng)養(yǎng)不良合并免疫低下發(fā)生率差異顯著(P0.001)。B組營(yíng)養(yǎng)不良合并免疫低下發(fā)生率顯著高于A組(P0.05),C組顯著高于A組(P0.001)和B組(P0.01)。另外,MNA-SF評(píng)分與白蛋白、前白蛋白、膽固醇、低密度脂蛋白、血紅蛋白的線性相關(guān)性均顯著(P0.05)。不同年齡組白蛋白、低密度脂蛋白、血紅蛋白、體重指數(shù)(BMI)差異均顯著(P0.05)。A組患者白蛋白顯著高于B組患者(P=0.014,P0.05)和C組患者(P=0.039,P0.05);A組患者低密度脂蛋白顯著高于B組患者(P0.001)和C組患者(P=0.002,P0.01);A組患者血紅蛋白顯著高于B組患者(P=0.009,P0.01)和C組患者(P0.001),B組顯著高于C組患者(P=0.044,P0.05)。C組患者BMI數(shù)值水平顯著低于A組患者(P=0.001,P0.01)和B組患者(P=0.012,P0.05),B組顯著低于A組(P=0.038,P0.05),隨年齡增長(zhǎng),BMI數(shù)值水平下降。其中感染性患者合并營(yíng)養(yǎng)不良組中營(yíng)養(yǎng)支持比例為38.5%;而免疫水平差的患者給予免疫支持治療的比例也僅為24.8%;營(yíng)養(yǎng)不良合并免疫功能低下同時(shí)給予營(yíng)養(yǎng)及免疫支持治療總比例僅為14.6%。結(jié)論:(1)肺部感染老年患者,營(yíng)養(yǎng)不良及免疫功能低下發(fā)生率高,并且隨著年齡增長(zhǎng),更易發(fā)生營(yíng)養(yǎng)不良及免疫功能低下。(2)肺部感染存在營(yíng)養(yǎng)不良及免疫功能低下的老年患者,臨床工作中給予營(yíng)養(yǎng)及免疫支持干預(yù)的比例低。(3)白蛋白、前白蛋白、膽固醇、低密度脂蛋白、血紅蛋白的水平與機(jī)體營(yíng)養(yǎng)狀態(tài)相關(guān),其中白蛋白、低密低脂蛋白及血紅蛋白的水平與年齡相關(guān)。
[Abstract]:Objective: in the world, the number of deaths caused by infectious diseases accounts for about 30% of the total number of human deaths, and the elderly patients are more susceptible to infection due to their lower autoimmune function, multiple organ function decline, and many chronic basic diseases. The incidence of respiratory infection is significantly higher than that of young people. So how to prevent and control the occurrence and development of infected diseases, improve the prognosis of the patients and reduce the mortality has become the focus of clinical work. The poor function can prolong the prognosis of the infected patients and even aggravate the original infection, such a vicious cycle, which causes the patient to be prolonged, the body is getting worse and worse. Therefore, the quality of life is extremely good for the infected patients if they can assess the malnutrition and immune function as early as possible, and give positive intervention to the prognosis of the patients. It is of great significance. Because of the highest proportion of pulmonary infection in infectious diseases, this study specially investigates the nutritional status and immune function level of the patients with pulmonary infection. There is a survey on the nutritional level of the infected patients. However, the assessment of the nutritional status and immune level of the infected patients is still limited, especially in the elderly. The study of patients is less. This study is to evaluate the nutritional and immune function of hospitalized elderly patients with pulmonary infection, and to investigate the intervention of malnutrition and immunodeficiency in the elderly patients with pulmonary infection, and to provide the basis for optimizing the nutrition and immune support treatment of the elderly patients with pulmonary infection. 140 elderly patients who were diagnosed with pulmonary infection in No.1 Hospital of Jilin University, August 2016 -2017 years, aged more than 60 years old (average age 84.05 + 7.46 years), were divided into three groups, A group (60-74 years old), group B (75-89 years old) and C group (> 90 years old). After admission, the nutritional risk and immune function were screened and evaluated. The body mass index (Body mass index, BMI), cholesterol, low density lipoprotein (low densith lipoprotein, LDL), uric acid, creatinine, albumin, prealbumin, hemoglobin, retinol protein, and total lymphocyte count were analyzed and compared, and the proportion of clinical intervention in elderly patients with malnutrition and immunodeficiency was analyzed. According to the results of the analysis, statistical analysis was carried out with statistical software SPSS22.0, and the difference was statistically significant. Results: the study included 140 elderly patients with nutritional screening, 15 cases in group A, 99 in group B, 26 in group C, 68.6% (96/140) in total dystrophy, 80.7% (113/140), total dystrophy combined with immunization. The rate of low incidence was 58.6% (82/140). Among the different age groups, the rate of malnutrition and immunodeficiency were different. The incidence of malnutrition, the rate of hypofunction and the incidence of malnutrition combined with immunodeficiency were 40%, 53.3%, 26.7%, in group B, 66.7%, 79.8%, 54.5% in the group of B, and 92.3% in the group C, 100% in the order of 92.3%, 100% in turn. The incidence of malnutrition in 92.3%. group was significantly higher than that in group A (P0.05), in group B, in group C, in group C, in group A (P0.01) and in group B (P0.05). The incidence of immunocompromises in the group of different ages was significantly higher than that in the group of A (P0.05). In addition, there was significant difference in the incidence of malnutrition and immunocompromises in different age groups (P0.001) the incidence of malnutrition and immunocompromises in group.B was significantly higher than that in group A (P0.05), and in C group was significantly higher than that in group A (P0.001) and B group (P0.01). In addition, the linear correlation between MNA-SF score and albumin, prealbumin, cholesterol, low density lipoprotein and hemoglobin was significantly higher than that in group A. The difference of albumin, low density lipoprotein, hemoglobin and body mass index (BMI) in different age groups (P0.05) was significantly higher than that of group B (P=0.014, P0.05) and C group (P=0.039, P0.05) in group.A (P0.05), and low density lipoprotein in A group was significantly higher than that in B group and group patients. Erythroprotein was significantly higher than that in group B (P=0.009, P0.01) and group C (P0.001), and group B was significantly higher than that of group C (P=0.044, P0.05).C group, the BMI numerical level was significantly lower than that of the A group. The proportion of nutritional support in the dystrophy group was 38.5%, while the proportion of immune support treatment was only 24.8% in the patients with poor immunization level, and the total proportion of nutritional and immune support treatment was only 14.6%. conclusion: (1) the incidence of malnutrition and immunodeficiency was high in the elderly patients with lung infection. And with age, malnutrition and immunodeficiency are more likely to occur. (2) there is a low proportion of nutritional and immune support in the clinical work of elderly patients with malnutrition and immunodeficiency. (3) albumin, prealbumin, cholesterol, low density lipoprotein, hemoglobin level and body nutrition The levels of albumin, low density lipoprotein and hemoglobin were age-related.

【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R563.1

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