老年冠心病患者肺部感染危险因素及针对性干预措施研究

Study of risk factors of pulmonary infection and targeted interventions in elderly patients with coronary heart disease

目的研究老年冠心病合并肺部感染危险因素及针对性干预措施。方法选择河南省人民医院2019年9月至2020年9月收治的老年冠心病住院患者430例作为对照组,将其中出现肺部感染的40例作为A组,将未出现肺部感染的390例作为B组;再选择2020年10月至2021年10月收治的老年冠心病住院患者400例作为观察组。根据对照组情况分析可能导致肺部感染危险因素、炎症因子指标变化情况,其中对照组患者给予院内常规冠心病干预,观察组在对照组基础上,根据对照组研究获得的危险因素进行针对性干预,分析不同干预措施的实施效果。结果单因素分析结果显示老年冠心病合并肺部感染患者与非感染患者住院时间、入侵性操作(包括:气管插管、导尿管、中心静脉置管、其他操作)、家属探视频次例数间差异有统计学意义(χ^(2)=44.383、73.568、50.920、31.466、22.424、6.388,P<0.05);多因素分析结果显示老年冠心病合并肺部感染危险因素为住院时间>30 d、进行过入侵性操作(包括:气管插管、导尿管、中心静脉置管、其他操作)、家属探视频次≥2次/d(χ^(2)=29.619、23.694、16.525、15.153、10.850、4.205,P<0.05)。A组入院次日清晨及感染后血清白介素-6(IL-6)、白介素-8(IL-8)、超敏C反应蛋白(hs-CRP)含量均高于B组,差异有统计学意义(t_(入院次日清晨)=6.072、6.532、7.533,t_(感染后)=8.411、19.930、39.048,P<0.05)。观察组感染发生率、住院时间均低于对照组(χ^(2)/t=4.998、4.493,P<0.05),且观察组感染患者住院时间低于对照组感染患者(t=2.596,P<0.05),差异均有统计学意义。结论老年冠心病合并肺部感染危险因素复杂多样,且感染的发生与体内炎症指标变化存在一定关联;临床医护人员可通过针对性预防措施降低其感染率,同时缩短患者住院时间。

Objective To study the changes of risk factors,inflammatory factors and nursing intervention measures in elderly patients with coronary heart disease complicated with pulmonary infection.Methods430 elderly patients with coronary heart disease admitted to our hospital from September 2019 to September 2020 were selected as control group,of which 40 patients with pulmonary infection as group A,and 390 patients without pulmonary infection as group B.400elderly inpatients with coronary heart disease who were admitted from October 2020 to October 2021 were selected as the observation group.The changes of risk factors and inflammatory factors that might lead to pulmonary infection were analyzed according to the situation of the control group.The patients in the control group were given routine coronary heart disease care in the hospital,and the patients in the observation group were given targeted nursing care based on the risk factors obtained from the study of the control group.The effects of different interventions were analyzed.ResultsThe results of univariate analysis showed that there were significant differences in hospitalization time,invasive operation(including:tracheal intubation,urinary catheter,central venous catheter,other operations),and the number of visits by family members between elderly patients with coronary heart disease complicated with pulmonary infection and non-infected patients(χ^(2)=44.383,73.568,50.920,31.466,22.424,6.388,P<0.05).The risk factors of heart disease complicated with pulmonary infection were hospital stay>30 days,invasive operation(including:tracheal intubation,urinary catheter,central venous catheter,other operations),family visits≥2 times/d(χ^(2)=29.619,23.694,16.525,15.153,10.850,4.205,P<0.05).The levels of serum interleukin-6(IL-6),interleukin-8(IL-8)and high-sensitivity C-reactive protein(hs-CRP)in control group A before infection and on the day of infection were higher than those in control group B(tEarly_(morning the next day after admission)=6.072,6.532,7.533,t_(After infection)=8.411,19.930,39.048,P<0.05).The incidence of infection and length of hospital stay in the observation group were lower than those in the control group(χ^(2)/t=4.998,4.493,P<0.05),and the incidence of hospitalization in patients with infection in the observation group was lower than those in the control group(t=2.596,P<0.05).ConclusionsThe risk factors of coronary heart disease complicated with pulmonary infection in the elderly were complex and diverse,and the occurrence of infection was related to the changes of inflammatory indicators in the body.Clinical staff could reduce the infection rate and shorten the hospitalization time of patients through targeted preventive measures.