老年COPD患者医院感染129例临床分析

Clinical analysis of 129 cases of nosocomial infection in aged patients with chronic obstructive pulmonary disease

目的 探索老年慢性阻塞性肺疾病 (COPD)患者医院感染的特点和预防措施。 方法 对 35 8例老年COPD患者医院感染情况进行回顾性调查。 结果 医院感染率为 36 0 3 % ,病死率为 13 95 % ,明显高于非医院感染死亡率 (P <0 0 1)。感染多发生在重症 (5 1 16 % )及冬季 (45 74% )。感染部位以下呼吸道为主 (76 74% )、感染与住院时间长、长期联用多种抗生素、使用糖皮质类固醇激素 (GCS)、免疫低下、营养差及侵入性操作等有关。感染以革兰阴性杆菌为主 (83 87% ) ,其中绿脓杆菌 (2 3 39% )和大肠杆菌 (2 0 97% )最多。 结论 应重视各种诱发因素及采取综合性预防措施 ,才能有效地减少医院感染。

Objective To investigate the characteristics and preventive measures of nosocomial infection of aged patients with chronic obstructive pulmonary disease(COPD). Methods Retrospective survey were carried out in 358 aged patients with COPD for the situation of nosocomial infection. Results Total nosocomial infection rate was 36 03% and the mortality was 13 95%,significantly higher than that of uninfected cases(χ 2=15 08, P <0 01).The infection rate increased among severe patients(51 16%)and in winter(45 74%).The lower respiratory tract was found to be the most commonly involved sites(76 74%).Nosocomial infection is related to long period hospitalization,long duration of combined antibiotics and steroids,dysfunction of immunity,malnutrition and aggressive procedures.The most common bacteria were gram-negative bacilli(83 87%).Most of them were pseudomonas aeruginosa(23 39%)and escherichia coli(20 97%). Conclusions Attention should be paid to all kinds of induced factors and comprehensive measures should be applied to reduce nosocomial infection.