老年心脑血管病患者医院感染的临床特点及危险因素分析

Clinical characteristics of nosocomial infections in senile cardiovascular disease patients and analysis of risk factors

目的分析老年心脑血管病患者医院感染的临床特点,并找出相应的危险因素,以降低感染率。方法回顾性分析2009年4月-2012年6月老年心脑血管病的241例患者,收集入选患者的临床资料、行为学资料、病史等,数据皆录入Excel 2003年建立数据库,分析与其相关的危险因素,模型筛选采用Stepwise法。结果 241例老年心脑血管病患者中发生医院感染56例,感染率为23.24%,其中呼吸道、泌尿系统、胃肠道感染分别占53.6%、32.1%、8.9%;病原菌以革兰阴性菌为主占60.0%;卧床(OR=1.769,95%CI:1.420～2.115)、脑血管意外(OR=6.447,95%CI:1.826～22.769)、假性球麻痹(OR=1.863,95%CI:1.709～2.051)、大小便不能自理(OR=1.539,95%CI:1.042～2.635)、气管切开(OR=3.640,95%CI:2.169～6.193)等是老年心脑血管病患者医院感染的主要危险因素。结论老年心脑血管病患者医院感染以革兰性阴性菌为主,脑血管意外、卧床、假性球麻痹、大小便不能自理、气管切开等是老年心脑血管病患者医院感染的主要危险因素。

OBJECTIVE To analyze the clinical characteristics of the nosocomial infections in the senile cardiovascu- lar disease patients and find out risk factors so as to reduce the infection rate. METHODS A total of 241 cases of senile patients with cardiovascular disease, who were treated in the hospital from Apr 2009 to Jun 2012 , were ret- rospectively analyzed; then the clinical data, ehavioral data, and disease history of the patients were collected and were input to Excel 2003 so as to establish the database; finally the related risk factors were analyzed, and the models were screened by using stepwise method. RESULTS Of 241 cases of senile patients with cardiovascular disease, the nosocomial infections occurred in 56 cases with the infection rate of 23.24%;among which 53.6% were with respiratory tract infections, 32.1 % with urinary tract infections, and 8.9% with gastrointestinal tract infections. The gram--negative bacteria were the predominant pathogens, accounting for 60.0 %. The bedridden （OR=1.769, 95% CI： 1. 420~2.115）, cerebrovascular accident （OR=6.447, 95% CI.. 1. 826~22. 769）, pseudo bulbar paralysis （OR=1. 863, 95% CI： 1. 709~2. 051）, losing ability of toileting （OR=1. 539 95% CI： 1. 042~2. 635）, and tracheotomy （OR=3. 640, 95% CI： 2. 169~6. 193） were the main risk factors of nosocomi- al infections in the senile patients with cardiovascular disease. CONCLUSION The gram-negative bacteria are the main pathogens causing nosocomial infections in the senile patients with cardiovascular diseases. The bedridden, cerebrovascular accident, pseudo bulbar paralysis, losing ability of toileting, and tracheotomy are the major risk factors of the nosocomial infections in the senile patients with cardiovascular disease.