發(fā)布時(shí)間：2018-05-05 15:40

  本文選題：老年多器官衰竭 + 臨床特征　； 參考：《蘇州大學(xué)》2013年碩士論文

【摘要】：目的 1.本研究通過對(duì)老年多器官衰竭（Mutiple organ failure in the elderly，MOFE）病例及對(duì)照病例的臨床特征、生存時(shí)間、危險(xiǎn)因素的調(diào)查研究，，為臨床早期診斷、治療和有效的二級(jí)預(yù)防、三級(jí)預(yù)防提供科學(xué)依據(jù)。 對(duì)象與方法 1.對(duì)象：從通遼老年病醫(yī)院老干部病房1998年9月至2008年8月期間門診就診及住院治療的病人中選取符合MOFE組和對(duì)照組入選標(biāo)準(zhǔn)的患者為研究對(duì)象。 2.方法：參照MOFE的診斷標(biāo)準(zhǔn)及病例-對(duì)照研究的設(shè)計(jì)要求，我們采用1:3配比病例對(duì)照研究和隨訪研究的方法，分別對(duì)研究對(duì)象進(jìn)行一般情況（年齡、性別），基礎(chǔ)疾病的情況（數(shù)量、病種、輕重程度），臨床表現(xiàn)（癥狀、體征、實(shí)驗(yàn)室檢查、輔助檢查等）、序貫發(fā)生器官衰竭的時(shí)間、序貫發(fā)生器官衰竭的順序、患者的生存時(shí)間、危險(xiǎn)因素（誘因、疾病狀態(tài)）等進(jìn)行調(diào)查隨訪研究。 3.統(tǒng)計(jì)分析：全部數(shù)據(jù)用SAS9.13進(jìn)行統(tǒng)計(jì)分析。定量資料用均數(shù)和標(biāo)準(zhǔn)差描述，定性資料用率及其95%可信區(qū)間描述；均衡性檢驗(yàn)定量資料采用t檢驗(yàn)，定性資料采用x2檢驗(yàn)，當(dāng)p值接近0.05時(shí)用Fisher確切概率法。衰竭器官分期資料的分析采用秩和檢驗(yàn)。病例對(duì)照OR值及其95%可信區(qū)間的計(jì)算采用單因素和多因素條件Logistic回歸分析。生存率的計(jì)算和生存曲線的制作采用乘積限法。生存時(shí)間用四分位法，老年多器官衰竭死亡與危險(xiǎn)因素和慢性基礎(chǔ)疾病的RR值及其95%可信區(qū)間計(jì)算均采用Cox回歸分析。所有報(bào)告的P值均為雙側(cè)檢驗(yàn)。 結(jié)果 本次研究我們共收集MOFE患者153人，調(diào)查隨訪后，發(fā)現(xiàn)死亡113人，存活40人。MOFE的生存率26.14%，病死率73.69%同時(shí)按照對(duì)照組的入選標(biāo)準(zhǔn)，隨機(jī)選取459人做為對(duì)照組。研究發(fā)現(xiàn)，MOFE患者最少累及2個(gè)衰竭器官，最多累及8個(gè)衰竭器官，死亡病例平均累及4.25個(gè)衰竭器官，存活病例平均累及3個(gè)衰竭器官；存活病例衰竭器官的個(gè)數(shù)明顯少于死亡病例衰竭器官的個(gè)數(shù)（P＜O.OOO)；所有MOFE患者不同衰竭器官臨床分期之間構(gòu)成比有明顯差別（P＜O.OOO)。 MOFE序貫發(fā)生器官衰竭的時(shí)間間隔多在10天以內(nèi)（66.01%）一般不超過1個(gè)月（19.61%）。MOFE首衰器官多見于肺臟（38.96%）、心臟（19.48%）、中樞神經(jīng)系統(tǒng)（14.94%）、腎臟（10.39%）、胃腸道（8.44%）等，序貫順序分布為：肺臟（42.9%）、心臟（40.9%）、腎臟（32.6%）、中樞神經(jīng)系統(tǒng)（21.9%）、胃腸道（14.5%）等。 MOFE患者50%的生存時(shí)間為243天（69～601天）。不同首衰器官由短到長(zhǎng)的生存時(shí)間分別為：肺臟26天、中樞神經(jīng)系統(tǒng)42天、心臟623天、腎臟1106天。 MOFE發(fā)病前患者一般均存在2種或2種以上的慢性基礎(chǔ)疾病，3～6種者約占76.47%；最多的患有11種基礎(chǔ)疾病（0.65%）；易發(fā)疾病為：冠心病（69.93%）、高血壓（55.56%）、多發(fā)性腦梗塞（49.02%）、慢性支氣管（37.25%）、老年肺炎（33.99%）、糖尿�。�1、2型）（24.84%）和動(dòng)脈硬化性腎�。�22.88%）。 單因素分析結(jié)果顯示：營(yíng)養(yǎng)狀態(tài)不良、免疫功能低下、精神障礙、腸道營(yíng)養(yǎng)攝入障礙、環(huán)境氣候的急劇變化、單一或多器官功能不全、感染、低T3綜合癥、電解質(zhì)紊亂、酸堿失衡、低蛋白血癥或低血糖、慢性貧血、心律失常、心肌缺血發(fā)作、出血性卒中、缺血性卒中手術(shù)或創(chuàng)傷、精神打擊等18個(gè)危險(xiǎn)因素的暴露率在MOFE組和對(duì)照組之間的差別有明顯的統(tǒng)計(jì)學(xué)意義（P＜0.023～0.000），表明上述危險(xiǎn)因素存在條件下，患者更易出現(xiàn)MOFE。而營(yíng)養(yǎng)狀態(tài)不良、免疫功能低下、腸道營(yíng)養(yǎng)攝入障礙、環(huán)境氣候的急劇變化、電解質(zhì)紊亂、低蛋白血癥或低血糖、慢性貧血、心肌缺血發(fā)作等8個(gè)危險(xiǎn)因素的暴露率在MOFE患者死亡組和存活組之間的差別有明顯的統(tǒng)計(jì)學(xué)意義（P＜0.04～0.000）。表明上述危險(xiǎn)因素存在條件下，患者更易出現(xiàn)MOFE患者的死亡。 為進(jìn)一步探討MOFE發(fā)生與危險(xiǎn)因素（誘因）的關(guān)聯(lián)程度，同時(shí)控制混雜因素，先進(jìn)行單因素條件Logitic回歸分析，對(duì)單因素有統(tǒng)計(jì)學(xué)意義因素，再進(jìn)行多因素分析，結(jié)果最終進(jìn)入多因素條件Logitic回歸模型的變量為：免疫功能低下、腸道營(yíng)養(yǎng)攝入障礙、感染、電解質(zhì)紊亂。其OR及95%CI為：5.26（2.10～13.19）、8.09（2.73～23.96）、9.33（3.43～25.37）、28.75（5.58～148.11）。 為探討MOFE發(fā)生與危險(xiǎn)因素（疾病狀態(tài)）的關(guān)聯(lián)程度，同時(shí)控制混雜因素，先進(jìn)行單因素條件Logitic回歸分析，對(duì)單因素有統(tǒng)計(jì)學(xué)意義因素，再進(jìn)行多因素條件Logitic回歸分析，結(jié)果最終進(jìn)入模型的變量為：營(yíng)養(yǎng)狀態(tài)不良、精神障礙、慢性貧血、心律失常、心肌缺血發(fā)作、出血性腦卒中、手術(shù)或創(chuàng)傷、精神打擊。其OR及95%C1為：3.48（1.73～6.97）、4.57（1.84～11.27）、12.16（4.70～31.48）、2.80（1.41～5.55）、2.45（1.29～4.74）、7.17（1.20～43.00）、3.75（1.37～10.26）、3.95（1.08～14.54）、7.84（1.71～36.00）。 結(jié)論 MOFE發(fā)病前均患有2種以上基礎(chǔ)疾病，最多患11種疾病，有某種誘因激發(fā)，以短時(shí)間序貫發(fā)生多個(gè)器官衰竭為特征，最多可累及8個(gè)衰竭器官，首衰器官分布以肺、心、中樞神經(jīng)及腎占前四位。多發(fā)序貫順序肺列第一位，心和腎臟列二、三位。有50%病人發(fā)病后平均生存243天。以肺和中樞為首衰器官生存時(shí)間最短。發(fā)現(xiàn)營(yíng)養(yǎng)狀態(tài)不良、免疫功能低下、精神障礙、腸道營(yíng)養(yǎng)攝入障礙、感染、電解質(zhì)紊亂、慢性貧血、心律失常、心肌缺血發(fā)作、出血性卒中、手術(shù)或創(chuàng)傷、精神打擊等12個(gè)因素是MOFE發(fā)病的獨(dú)立危險(xiǎn)因素。
[Abstract]:objective
1. by investigating the clinical features, survival time and risk factors of Mutiple organ failure in the elderly (MOFE) cases and control cases, this study provides a scientific basis for early clinical diagnosis, treatment and effective two level prevention and three level prevention.
Object and method
1. subjects: selected patients from the MOFE and the control groups from September 1998 to August 2008 in the old cadre ward of the Tongliao geriatric hospital for the study and the control group.
The 2. method: referring to the diagnostic criteria of MOFE and the design requirements of case control study, we used a 1:3 matched case-control study and follow-up study to carry out the general situation (age, sex), the condition of the basic disease (quantity, disease, degree), clinical manifestation (symptoms, signs, laboratory examination, auxiliary examination). The time of sequential organ failure, the sequence of sequential organ failure, the patient's survival time, the risk factors (inducement, disease state), etc. were investigated and followed up.
3. statistical analysis: all data were analyzed by SAS9.13. Quantitative data were described with mean and standard deviation, qualitative data utilization and its 95% confidence interval; t test was used for quantitative data of equilibrium test. Qualitative data was tested by x2 test. The exact probability method of Fisher was used when the value of P was close to 0.05. The analysis of the staging data of the failure organs was adopted. The rank sum test. The case control OR value and the 95% confidence interval were calculated by single factor and multiple factor conditional Logistic regression analysis. The survival rate calculation and the survival curve were made by the product limit method. The survival time using the four subdivision method, the RR value of the death and risk factors and the slow basic diseases in the elderly and the 95% confidence interval meter. The Cox regression analysis was used. All the P values of the reports were bilateral tests.
Result
In this study, we collected 153 patients with MOFE. After the follow-up, we found that 113 people died, and the survival rate of 40 people was 26.14%. The fatality rate was 73.69% at the same time. At the same time, 459 people were randomly selected as the control group according to the standard of the control group. The study found that the patients with MOFE were least involved in 2 exhaustive organs, with the maximum of 8 exhaustion organs and the average death cases. 4.25 exhaustion organs were involved, and the survival cases involved an average of 3 exhaustion organs, and the number of failure organs in the survival cases was significantly less than that of the dead organ failure organs (P < O.OOO); the ratio of the clinical stages of all MOFE patients was significantly different (P < O.OOO).
The time interval between MOFE sequential organ failure is more than 10 days (66.01%) generally not more than 1 months (19.61%).MOFE first failure organs in the lung (38.96%), heart (19.48%), central nervous system (14.94%), kidney (10.39%), gastrointestinal (8.44%), and so on. The sequential distribution is lung (42.9%), heart (40.9%), kidney (32.6%), central nervous system System (21.9%), gastrointestinal tract (14.5%), etc.
The survival time of 50% of patients with MOFE was 243 days (69~601 days). The survival time of different first failure organs from short to long was 26 days in the lungs, 42 days in the central nervous system, 623 days in the heart, and 1106 days in the kidney.
Before MOFE, there were 2 or more than 2 chronic basic diseases, 3~6 of which accounted for 76.47%, and the most had 11 basic diseases (0.65%); the prone diseases were coronary heart disease (69.93%), hypertension (55.56%), multiple cerebral infarction (49.02%), chronic bronchitis (37.25%), senile pneumonia (33.99%), diabetes (24.84%) (24.84%) and movement. Arteriosclerotic nephropathy (22.88%).
The results of single factor analysis showed: poor nutritional status, low immune function, mental disorder, intestinal nutrition intake disorder, rapid changes in environmental climate, single or multiple organ dysfunction, infection, low T3 syndrome, electrolyte disorder, acid-base imbalance, hypoproteinemia or hypoglycemia, chronic anemia, arrhythmia, myocardial ischemia attack, bleeding The exposure rates of 18 risk factors, such as stroke, ischemic stroke surgery or trauma, and mental shock, were significant statistically significant between the MOFE group and the control group (P < 0.023 to 0), indicating that the patients were more susceptible to MOFE. and poor nutritional status, low immune function, intestinal nutrition intake disorder, and rings under the conditions of the above risk factors. The exposure rates of 8 risk factors, such as dramatic changes in climate, electrolyte disturbance, hypoproteinemia or hypoglycemia, chronic anemia, and myocardial ischemia, have significant statistical significance between the death and survival groups of MOFE patients (P < 0.04 to 0). Death.
In order to further explore the degree of association between MOFE and risk factors (inducement), and control confounding factors and advanced single factor conditional Logitic regression analysis, the single factor had statistical significance, and then multifactor analysis was carried out. The result of the final entry into multi factor conditional Logitic regression model was: low immune function and enteral nutrition intake. OR and 95%CI were 5.26 (2.10 to 13.19), 8.09 (2.73 to 23.96), 9.33 (3.43 to 25.37), 28.75 (5.58 to 5.58).
To investigate the degree of association between MOFE and risk factors (disease status), and control confounding factors and advanced single factor conditional Logitic regression analysis, the single factor had statistical significance, and then multiple factor conditional Logitic regression analysis was carried out. The results of the final entry into the model were: malnutrition, mental disorder, chronic anemia, Arrhythmia, ischemic attack of myocardium, hemorrhagic stroke, operation or trauma, and mental shock. Its OR and 95%C1 are 3.48 (1.73 to 6.97), 4.57 (1.84 to 11.27), 12.16 (4.70 to 31.48), 2.80 (1.41 to 5.55), 2.45 (2.80).
conclusion
Before the onset of MOFE, there were more than 2 kinds of basic diseases, with a maximum of 11 diseases, a certain inducement, multiple organ failure in a short time sequence, and a maximum of 8 exhaustion organs. The first organ of the first failure was the first four in the lungs, heart, central nerve and kidney. The first sequence of the lung, the two of the heart and the kidneys, three. 50% The average survival time of the patients was 243 days after the onset of the disease. The survival time was the shortest with the lung and the central nervous system. The 12 factors, such as poor nutritional status, low immune function, mental disorder, intestinal nutrition intake disorder, infection, electrolyte disorder, chronic anemia, arrhythmia, myocardial ischemia, hemorrhagic stroke, operation or trauma, mental shock, were MOFE An independent risk factor for the disease.

【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R592

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