老年心律失常患者医院感染的临床分析

Clinical analysis of nosocomial infections in elderly patients with cardiac arrhythmias

目的探讨老年心律失常患者医院感染的临床特点及影响因素,为早期防治提供依据。方法对医院2010年10月-2012年11月收治的815例老年心律失常患者医院感染率、感染部位、病原菌、感染相关因素及感染前后心律失常的特点进行回顾性分析。结果 815例老年心律失常患者发生医院感染86例,感染率10.6%,感染部位以呼吸道感染最常见,占52.3%,其中下呼吸道感染占36.1%,上呼吸道感染占16.3%;其次为泌尿道、胃肠道、口腔、穿刺部位、皮肤感染,分别占14.0%、11.6%、9.3%、8.1%、2.3%;单部位感染占73.3%,2个部位感染占17.4%,≥3个部位感染占9.3%;病原菌以革兰阴性杆菌多见,占54.0%,其次为革兰阳性球菌和真菌,分别占30.0%和16.0%;感染的发生与患者年龄、住院天数、有创诊治、器质性心脏病相关,差异有统计学意义(P<0.05),与性别无关;老年心律失常患者发生医院感染后室上性、室性早搏及≥2种或心律失常明显增多,差异有统计学意义(P<0.05)。结论临床医师应掌握老年心律失常患者医院感染临床特点及影响因素,减少医院感染的发生,避免心律失常恶化。

OBJECTIVE To explore the clinical characteristics of the elderly patients with cardiac arrhythmia complicated with nosocomial infections and explore the influencing factors so as to guide the early prevention and treatment.METHODS A total of 815 cases of elderly patients with cardiac arrhythmia,who were treated in the hospital from Oct 2010 to Nov 2012 were enrolled in the study,then the incidence of nosocomial infection,infection site,pathogens,risk factors for infections,and the characteristics of cardiac arrhythmia were retrospectively analyzed.RESULTS Among the 815 senile patients with cardiac arrhythmias,the nosocomial infections occurred in 86 patients with the infection rate of 10.6%,among which the patient with respiratory tract infections accounted for 52.3%（including 36.1% of lower respiratory tract infections and 16.3% of upper respiratory tract infections）,the patients with urinary tract infections 14.0%,the patients with gastrointestinal tract infections 11.6%,the patient with oral cavity infections 9.3%,the patients with puncture site infections 8.1%,and the patients with skin infections 2.3%;the patients with single site infections accounted for 73.3%,the patients with two-site infections 17.4%,the patients with more than three-site infections 9.3%.The gram-negative bacilli were the most common pathogens,accounting for 54.0%,followed by the gram-positive cocci（30.0%）and the fungi（16.0%）.The incidence of infections was related to the age,hospitalization duration,invasive diagnosis and treatment,or organic heart disease,the difference was statistically significant（P0.05）,while it had nothing to do with the gender.The incidence of the supraventricular,premature ventricular contraction or the more than two kinds of arrhythmia increased significantly in the elderly patients with cardiac arrhythmias complicated with nosocomial infections,the difference was statistically significant（P0.05）.CONCLUSIONThe clinicians should understand and master the clinical characteristics and influencing factors for nosocomial infections in the cardiac arrhythmia patients so as to reduce the incidence of nosocomial infections and avoid the exacerbation of arrhythmia.