老年长期卧床患者继发肺部感染特点及危险因素研究

Risk Factors and Clinical Characteristics of Bedridden- associated Pneumonia in Elderly Patients

目的 探讨老年长期卧床患者继发肺部感染的临床及病原学特点,以及影响预后的独立危险因素.方法 回顾性分析2013年4月1日～ 2014年4月1日因肺部感染入院的、患者年龄≥65岁、卧床时间＞3个月的患者,共58例,分为低龄老年组（≤80岁）及高龄老年组（＞ 80岁）,比较组间临床及实验室等特点的差异;并对肺部感染预后的相关危险因素进行多因素回归分析.结果 58例患者男女性别比为34∶24,患者平均年龄80±8岁,卧床时间中位数为12个月,病死率13.8％ （8/58）.100％的患者有新发咳嗽咳痰或原有咳嗽咳痰加重,临床起病以低热为主（30例,55.6％）,入院1周内谵妄、显性呛咳比例分别为53.4％ （31/58）及58.6％ （34/58）.入院后首次化验显示高龄组CRP及动脉血二氧化碳分压（PaCO2）均高于低龄组,而血肌酐水平低于正常范围及高于正常范围的比例均高于低龄组.影像学以双侧渗出为主（37例,63.8％）.致病细菌中,G-杆菌感染居首位（46例,79.3％）,G＋球菌次之（11例,19％）.真菌感染31例（53.4％）,白假丝酵母菌最常见（19例,61.3％）.多因素回归分析显示,有COPD病史、入院前已留置导尿、入院后血肌酐水平高于正常、首次动脉血pH＞ 7.446、首次动脉血氧分压（PaO2）＜79mmHg、入院后需肠外营养支持、合并真菌感染及双肺受累是长期卧床老年患者继发肺部感染预后不佳的独立危险因素.结论 老年长期卧床患者继发肺部感染的发生率、病死率高,加之临床特点不典型容易漏诊或延迟诊断,临床医师应尽可能做到及早发现、严密监测并有针对性地给予相应治疗.

Objective To analyze the clinical and pathogen characteristics and risk factors of bedridden-associated pneumonia in elderly patients.Methods We retrospectively investigated 58 elderly pneumonia patients in our hospital between 1 April 2013 to 1 April 2014,whose age was ≥ 65yrs,bedridden time ＞ 3months.The patients were divided into younger elderly group（≤ 80yrs）and very elderly group （＞ 80 yrs）,then the clinical and laboratory characteristics were differentiated between groups.Risk factors associated with the pneumonia was analyzed by multivariate regression analysis.Results Of 58 patients,male was 34 cases,female 24 cases,with mean age 80 ± 8 years old,and bedridden median time was 12 months,the mortality rate was 13.8％ （8 cases）.100％ of patients got new-onset or increased cough and sputum.Dominated fever was low grade（30 cases,55.6％）.During first hospitalized week,incidence of delirium and aspiration were 53.4％ （31） and 58.6％ （34）.Initial examination indicated that the level of CRP and arterial PaCO2 in very elderly group were higher than younger group,and serum creatinine level in abnormally,were higher than the latter.Imaging with bilateral exudation dominated （37,63.8％）.As for the pathogenic bacteria,G-bacillus most （46,79.3％）,G ＋ cocci followed （11,19％）.Fungal infection was in 31 cases（53.4％）,in which Candida albicans was the most （19,61.3％）.Multivariate logistic regression analysis showed the independent risk factors of the poor prognosis of bedridden elderly pneumonia patients：COPD,catheterization before hospitalization,serum creatinine levels higher than normal,arterial blood pH value ＞ 7.446,arterial PaO2 ＜ 79mmHg,requiring parenteral nutrition after admission,combined fungal infections and bilingual lung involvement.Conclusion Pneumonia incidence and mortality of bedridden elderly patients was high,and atypical clinical features caused the diagnosis been easily missed or delayed,so clinicians should be find out it as early as possible,monitoring closely and targeted to give appropriate treatment.