呼吸科与重症监护室院内获得性肺炎预后因素分析

Analysis of prognostic factors of hospital-acquired pneumonia: comparison between the respiratory medicine department and intensive care unit

目的通过对浙江大学医学院附属第一医院呼吸科和监护室(ICU)院内获得性肺炎(HAP)患者资料进行回顾性分析,以寻找不同科室患者HAP发生的危险因素的异同,从而针对不同人群建立特异的预防HAP的决策。方法采取回顾性研究,收集2011年6月1日至2013年9月30日浙江大学附属第一医院呼吸科和ICU出院诊断为肺炎(年龄≥18岁)的病历资料,比较两科室患者基本资料、基础疾病等方面的差别,然后对HAP患者危险因素进行分析,对筛选出来的P<0.05的因素再进行Logistic多因素回归分析。结果逐步Logistic回归(Backward:Wald)分析提示,呼吸科危险因素为血液及实体肿瘤病史而ICU危险因素为感染性休克与近期重大手术史。结论两科室存在不同的影响预后的危险因素,ICU院内获得性肺炎的发病率、死亡率明显高于呼吸科,这与患者基础疾病有密切关系。

Objective To explore the risk factors of hospital-acquired pneumonia（ HAP） in the department of respiratory medicine and intensive care unit and make more specific preventive measures for clinical practice. Methods A retrospective analysis was performed on the medical records of patients diagnosed as pneumonia upon discharge from our hospital during Jun 01 2011 and Sep 30 2013; their basic data and underling diseases were compared,and the risk factors associated with HAP were identified by Chi-square test（ P 〈 0. 05） and Logistic regression. Results The risk factors in the department of respiratory medicine were history of hematologic tumor and solid tumors,comparative to that of septic shock and major surgery in intensive care unit. Conclusion There is significant difference in the risk factors between the two departments,and ICU has higher morbidity and mortality than respiratory medicine department does,which is closely associated with patients’ underling diseases.