重症肌无力患者院内肺部感染的相关因素分析

Analysis of factors influencing nosocomial pneumonia in patients with myasthenia gravis

目的探讨重症肌无力(MG)患者院内肺部感染的危险因素和保护因素。方法回顾性分析228例MG住院患者的资料,分析发生院内肺部感染的相关因素。结果 MG患者院内肺部感染的发生率为15.8%。单因素Logistic回归分析发现与院内肺部感染相关的因素包括年龄(OR:1.609)、起病年龄(OR:1.648)、临床分型(OR:2.023)、吞咽困难(OR:3.064)、咳嗽无力(OR:9.000)、肌无力危象(OR:4.020)、糖皮质激素(简称"激素")用量(OR:2.180)、阿托品用量(OR:1.701)、新斯的明用量(OR:1.552)和辅助通气(气管切开或气管插管)(OR:1.716)等,多因素Logistic回归分析发现与院内肺部感染相关的因素包括起病年龄(OR:1.754)、咳嗽无力(OR:7.979)、激素用量(OR:2.334)、激素疗程(OR:3.031)、新斯的明用量(OR:0.407)、阿托品用量(OR:1.872)和辅助通气(OR:1.490)等。结论起病年龄大、咳嗽无力、大剂量应用激素、激素疗程长、大剂量应用阿托品及辅助通气等是MG患者发生院内肺部感染的危险因素,大剂量应用新斯的明为院内肺部感染的保护因素。

Objective To investigate the risk and protective factors for nosocomial pneumonia in myasthenia gravis (MG) patients.Methods Two hundred and twenty-eight cases of MG were surveyed retrospectively in a case control study.Logistic regression analysis was adopted to analyze the correlation factors for nosocomial pneumonia.Results The incidence of nosocomial pneumonia was 15.8%.Logistic single factor analysis showed the factors, including age (OR: 1.609), age of onset (OR: 1.648), clinical classification (OR: 2.023), dysphagia (OR: 3.064), cough weakness (OR, 9.000), myasthenia crisis (OR: 4.020), corticosteroid dosage (OR:2.180), atropine dosage (OR: 1.701), neostigmine dosage (OR: 1.552) and ventilation assistance (including tracheal incision and intubation) (OR:1.716), were significantly correlated with nosocomial pneumonia.Logistic multiple factors analysis showed that age of onset (OR:1.754), cough weakness (OR:7.979), corticosteroid dosage (OR:2.334), duration of corticosteroid treatment (OR:3.031), neostigmine dosage (OR:0.407), atropine dosage (OR:1.872) and ventilation assistance (OR: 1.490) were significantly related to nosocomial pneumonia.Conclusions Old age of onset, cough weakness, large dosage of corticosteroids, long-term corticosteroid treatment, large dosage of atropine and ventilation assistance were risk factors, whereas large dosage of neostigmine was a protective factor for nosocomial pneumonia in MG patients.