摘要
目的探讨老年冠心病合并心衰患者医院肺部感染的病原学特点、危险因素及预防对策。方法选取2015年1月至2017年6月以来收治的1056例老年冠心病合并心衰患者资料进行回顾性分析,总结分析肺部医院感染的病原学特点和相关危险因素。结果在收治的1056例患者中,有100例发生肺部感染,感染率为9.47%;病原菌78株,其中革兰阴性菌65.38%,革兰阳性菌34.62%;多因素logistic分析结果显示,有吸烟史、有糖尿病病史、住院时间长、营养状态差、有侵入性操作、有吞咽障碍和长期卧床是影响老年冠心病合并心衰患者发生肺部感染的独立危险因素。结论老年冠心病合并心衰患者肺部感染通常以革兰阴性菌为主,而有吸烟史、有糖尿病病史、住院时间长、营养状态差、有侵入性操作、有吞咽障碍和有长期卧床是影响患者肺部医院感染的独立危险因素。通过加强对冠心病病房的消毒工作、建立完善的环境监测体系,对患者采取戒烟、早期营养支持,并在治疗过程中严格无菌操作、尽量减少侵入性操作和合理使用抗菌药物,从而避免或降低老年冠心病合并心衰患者肺部感染的发生。
Objective To understand the etiological characteristics of nosocomial pulmonary infection in elderly patients with coronary heart disease(CAD)and heart failure comorbidity,and to discuss the risk factors.Methods A retrospective analysis was performed on clinical data of 1056 elderly patients with coronary heart disease and heart failure comorbidity treated in our hospital from January 2015 to June 2017.The pathogens of nosocomial pulmonary infections and related risk factors were analyzed.Results Out of 1056 patients,100 cases had nosocomial pulmonary infections with the overall infection rate of 9.47%.A total of 78 strains of pathogenic bacteria were isolated,including 65.38%of Gram-negative bacteria and 34.62%of Gram-positive bacteria.Multivariate logistic analysis showed that history of smoking and diabetes,longer hospital stay,poor nutritional status,invasive operation,dysphagia and long-term being bedridden were independent risk factors for pulmonary infection in elderly patients with coronary heart disease and heart failure comorbidity.Conclusions Gram-negative bacteria are the leading pathogens of nosocomial pulmonary infection in elderly patients with coronary heart disease and heart failure comorbidity.History of smoking and diabetes,longer hospital stay,poor nutritional status,invasive operation,dysphagia and long-term bed rest are independent risk factors for pulmonary infection Therefore,in order to prevent the nosocomial pulmonary infection,we should strengthen the disinfection of coronary heart disease wards and establish a sound environmental monitoring system,patients should be encouraged to quit smoking,early nutritional support should be proposed,strict aseptic operation procedures should be followed and invasive operation should be minimized.
作者
诸帆
胡申江
ZHU Fan;HU Shen-jiang(Department of Cardiology,First Affiliated Hospital of Zhejiang University,Hangzhou,Zhejiang,310003,China;不详)
出处
《中国预防医学杂志》
CAS
CSCD
2020年第7期749-753,共5页
Chinese Preventive Medicine
基金
浙江省湖州市第二批科技计划基金资助项目(2018GYB43)
关键词
老年患者
冠心病
心衰
肺部感染
病原菌
危险因素
干预措施
Elderly patients
Coronary heart disease
Heart failure
Pulmonary infection
Pathogen
Risk factors
Intervention
