COPD患者医院获得性肺炎临床分析

The clinical analysis of hospita1-acquired pneumonia in patients with CPOD

目的:分析我院住院慢性阻塞性肺疾病(COPD)患者医院获得性肺炎(HAP)特点,并分析有效临床处理方式。方法:回顾性分析2007年1月～2011年12月资料完整的496例COPD患者,全部COPD患者均进行痰细菌学检查,并对呼吸衰竭、年龄、咳嗽反射、心力衰竭、广谱抗菌素应用时间、气管插管/切开、机械通气和重症监护室(ICU)住院时间等9个候选因素进行二项Logistic回归分析。结果:COPD患者中HAP患病率21.98%(109/496),HAP病死率19.27%(21/109)。致病菌123株中以耐药肺炎克雷伯菌(21.14%)和铜绿假单胞菌(20.33%)最常见。结论:COPD患者HAP发生较高,主要致病菌是肺炎克雷伯菌和铜绿假单胞菌。HAP的发生与呼吸衰竭、年龄、应用广谱抗菌素、气管插管/切开、机械通气和ICU住院时间密切相关。选择合适的抗菌药物,加强ICU管理和早期防治是降低HAP发生的关键。

Objective. To analyze characteristics and clinical counter measures of hospital-acquired pneumonia （HAP） in patients with chronic obstructive pulmonary disease （COPD） in our hospital. Methods-Data of 496 cases admitted to our hospital from 2007 to 2011 were retrospectively analyzed. Sputum bacteriology was performed on all patients with COPD. Nine candidate factors including respiratory failure, age, cough reflex, heart failure, application of broad-spectrum antibiotic time, endotracheal intubation/ineision, mechanical ventilation and intensive care unit （ICU）, length of hospital stay were put through logistic regression analysis. Results. The prevalence rate of HAP was 21.98% （109/496） in patients with COPD, mortality rate was 19.27% （21/109）. Of the 123 pathogens strains, 21.14% were Klebsiella pneumoniae bacteria, and 20. 33~ were Pseudomonas aeruginosa. Conclusions： The results show that prevalence of HAP infection in patients with COPD is higher, which are mainly caused by Klebsiella pneumoniae and Pseudomonas aeruginosa. The respiratory failure, age, application of broad spectrum antibiotics, tracheal intubation / incision, mechanical ventilation and length of ICU stay are closely related with HAP occurrence. Select the appropriate antimicrobial drug, strengthen the ICU management and early prevention is the key to prevent HAP occurrence.