老年重症监护病房多重耐药菌肺炎危险因素及临床特点分析

Risk factors and clinical features of multidrug-resistant organism pneumonia in the elderly patients of ICU

目的探讨老年重症监护病房(ICU)多重耐药菌(multidrug-resistant organism,MDRO)肺炎的危险因素及临床特点。方法以老年ICU 32例MDRO肺炎患者为研究组,30例非MDRO肺炎患者为对照组,对年龄、基础疾病、住院天数、侵袭性治疗、院内应用抗菌药物及糖皮质激素等19项因素,及血小板减少、肝功能异常、贫血、凝血功能、心功能、酶学异常、低蛋白血症等10项并发症为观察指标分别进行logistic单因素和多因素回归分析,筛选多重耐药菌感染的相关危险因素及并发症并对其临床特点进行分析。结果与MDRO肺炎密切相关的因素依次为呛咳(OR=37.333)、合并脑血管病(OR=12.375)、合并心血管病(OR=6.750)、住院天数(OR=1.264)、年龄(OR=1.150),并发症中贫血(OR=12.375)、肝功能异常(OR=7.800)与MDRO感染密切相关。结论呛咳、合并脑血管病、合并心血管病、住院天数、年龄是MDRO肺炎的重要危险因素,MDRO肺炎患者易导致肝功能异常、贫血等严重并发症,导致死亡率增加。重视MDRO肺炎危险因素的防治并积极治疗并发症对改善预后具有重要意义。

Objective To investigate the risk factors and clinical features of multidrug-resistant organism(MDRO) pneumonia in the elderly patients of ICU.Methods Thirty-two geriatric patients in ICU suffering from MDRO pneumonia were enrolled as experimental group,and meanwhile 30 cases with non-multiple resistant bacteria were chosen as control.Nineteen indicators including age,underlying diseases,hospital stays,aggressive therapy,and antibiotics as well as glucocorticoids in hospital were surveyed,simultaneously 10 complications including thrombocytopenia,abnormal liver function,anemia,coagulation function,heart function,abnormal enzymes and hypoalbuminemia were also observed.Relative risk factors and complications associated with the MDRO infection were sifted by logistic regression analysis.Results Factors closely related to MDRO pneumonia were bucking(OR = 37.333),cerebrovascular disease(OR = 12.375),cardiovascular disease(OR = 6.750),hospital stays(OR = 1.264),age(OR = 1.150),complication with anemia(OR = 12.375) and abnormal liver function(OR = 7.800).Conclusions The important risk factors of MDRO pneumonia include bucking,cerebrovascular disease,cardiovascular disease,hospital stays and ages.Patients with MDRO pneumonia are prone to result in serious complications,such as abnormal liver function and anemia,which increases the mortality.It is important to prevent the risk factors of MDRO pneumonia and treat the complications actively.