老年冠心病患者医院感染的危险因素分析及干预对策

Risk factors for nosocomial infections in elderly patients with coronary disease and intervention measures

目的分析老年冠心病患者医院感染的危险因素分析,并制定预防策略,以降低医院感染率。方法回顾性分析2008年1月-2013年1月收治入院的289例老年冠心病患者的临床资料,统计患者可能导致感染的各项危险因素,采用单因素及多因素非条件logistic回归分析,模型筛选采用Stepwise法。结果 289例老年冠心病患者共发生医院感染46例,感染率15.9%,且以呼吸系统为主占56.7%;单因素分析显示,老年冠心病患者医院感染发生与高龄(>70岁)、住院天数长(>30d)、侵入性操作、长期使用广谱抗菌药物(≥20d)、合并严重基础疾病有关,差异有统计学意义(P<0.05);而多因素分析显示,侵入性操作的危险性最高(OR=4.258)。结论老年冠心病患者医院感染与患者年龄较高、侵入性操作较多等关系密切,临床应采取针对性干预对策,以降低感染发生率。

OBJECTIVE To analyze the risk factors for the nosocomial infections in the elderly patient with coronary disease and put forward prevention strateyies so as to reduce the incidence of the nosocomial infetcions. METHODS The clinical data of 289 cases of elderly patients with coronary heart disease from Jan 2008 to Jan 2013 were retrospectively analyzed, the risk factors that may result in the infections were statistically analyzed, then the univariate analysis and the multivariate nonconditional logistic regression analysis were performed, and the model screening was carried out with the use of stepwitse method. RESULTS Among the 289 cases of elderly patients with coronary heart disease, there were 46 patients with hospital infections with the infection rate of 15. 9%, among which the cases of respiratory tract infections accounted for 56.7 %; the univariate analysis showed that the incidence of infections in the elderly patients with coronary heart disease was related to old age （more than 70 years old）, long hospitalization duration （more than 30 d）, invasive operation, the long-term use of broad spectrum antibiotics（more than 20 d）, and severe basic diseases ,the difference was significant（P〈0.05）, and the multiva- riate analysis showed that the underlying invasive operation was the highest risk （OR = 4. 258）. CONCLUSION The incidence of nosocomial infection in elderly patients with coronary artery disease is closely related to the old age, invasive operation, and so on, clinics should adopt targeted intervention countermeasures so as to reduce the incidence of infections.