中晚期痴呆患者院内获得性肺炎的高发因素及应对策略

Risk factors and coping strategy of hospital-acquired pneumonia in patients with mid late dementia

目的探讨中晚期痴呆患者院内获得性肺炎的高发因素,为痴呆患者临床康复提供应对策略。方法回顾性分析436例中晚期痴呆患者的临床资料,分析院内获得性肺炎的发生率和病原菌特征,采用χ2检验分析相关影响因素。结果 436例痴呆患者发生肺部感染75例,感染率为17.20%;共分离出88株病原菌,革兰阴性菌59株占67.05%,革兰阳性菌22株占25.00%,真菌7株占7.95%;排名前5位的病原菌依次为铜绿假单胞菌、肺炎克雷伯菌、金黄色葡萄球菌、大肠埃希菌和表皮葡萄球菌,分别占29.55%、17.05%、13.64%、10.23%和9.09%;肺部感染与年龄、病程、住院时间、合并疾病情况、吞咽困难、侵入性操作、预防性使用抗菌药物和抗精神药物使用时间有关(P<0.05)。结论中晚期痴呆患者院内获得性肺炎的感染率较高,应针对其高发因素,采用相应的应对策略,降低肺部感染的发生率。

OBJECTIVE To study the risk factors of the hospital-acquired pneumonia in patients with the mid late dementia so as to offer the coping strategies for clinical recovery of the patients. METHODS The clinical data of 436 cases with the mid late dementia were reviewed. The incidence of hospital-acquired pneumonia and pathogenic features were analyzed, and the related factors were tested by X2 test. RESULTS The hospital-acquired pneumonia occurred in 75 cases with the incidence rate of 17.20% . A total of 88 strains of pathogens were isolated,including 59 （67.05%）strains of gram-negative bacteria, 22 （25.00%）strains of gram-positive bacteria, and 7 （7.95%） strains of fungi. The Pseudomonas aeruginosa , Klebsiella pneurnoniae , Staphylococcus aureus , Escherichia coli , and Staphylococcus epidermidis were the top 5 species of pathogens, accounting for 29.55 %, 17.05 %,13.64%, 10.23%, and 9. 09% , respectively. The pulmonary infections were related to the age, course, hospital stay, complications, dysphagia, invasive operation, prophylactic antibiotics , and the duration of antipsychoties used （P〈0.05）. CONCLUSION The incidence of hospital-acquired pneumonia is high in the patients with the mid late dementia. According to the risk factors, we should take the corresponding measures to reduce the incidence of the pulmonary infections.