90岁以上老年住院患者的临床特点及预后分析

Clinical characteristics and prognosis of over-90-year-old inpatients

摘要:

目的 了解超高龄老年（≥90岁）住院患者的住院现况及其住院死亡的相关危险因素。方法 从医院管理信息系统检索2014年12月1日至2015年11月30日期间从我院普通病区出院的所有年龄≥90岁的病例。采用回顾性分析方法，分别登记患者年龄、性别、就诊病因、住院病区、住院时间、转归等病历资料，从住院病历中和实验室信息系统系统提取入院时的生命体征以及入院时血常规、生化检查结果。结果 过去1年间，我院年龄≥90岁住院患者共231例，住院340例次，患者年龄（92.09±2.08）岁，中位住院时间10（5，16）d。入院诊断前3位疾病分别为肺部感染、冠心病和骨折。231例超高龄老年住院患者中死亡40例（17.32%）。死亡患者的前3位入院诊断分别为肺部感染、脑血管疾病和晚期恶性肿瘤。多因素分析显示，因肺部感染住院、休克指数（SI）≥0.7，中性粒细胞比例≥0.7，血尿素≥12mmol/L和白蛋白＜35g/L是高龄住院患者死亡的危险因素。结论 肺部感染是≥90老年患者最常见的入院原因，应加强超高龄老年住院患者炎症状态、循环状态和营养状态的评估。

Abstract:

Objective To investigate the status of the very old inpatients (≥90 years) and analyze the risk factors for hospital death. Methods All over-90-year-old inpatients who discharged from general wards of our hospital during December 2014 to November 2015 were identified from our hospital information system. Then a retrospective study was performed on their medical records and clinical data, such as age, sex, doctor-visit causes, wards, hospitalization time and prognosis, vital signs at admission, admission blood routine and biochemical examination results. Results During the study period, there were 340 admissions of 231 patients aged over 90 years in our hospital. They were at an average age of (92.09±2.08) years, and with a median hospital stay of 10d (ranging from 5 to 16d). The top 3 admitting diagnoses were pulmonary infection, coronary heart disease and hip fracture. There were 40 patients dead during hospitalization, with a mortality of 17.32%s. Among them, pneumonia, cerebral vascular disease and advanced cancer were recorded as the most common admitting diagnoses. Multivariate analysis showed that hospitalization due to pneumonia, shock index ≥0.7 at admission, neutrophil percentage ≥0.7, urea ≥12mmol/L, and serum albumin ＜35g/L were risk factors for hospital death in the cohort. Conclusion Pneumonia is the leading admitting diagnosis in the patients over 90 years old. Clinicians need to strengthen the assessment on inflammatory condition, as well as circulatory and nutritional status in the very old inpatients.