慢性阻塞性肺疾病患者医院感染临床特征与CAT评分的评估

Clinical characteristics and CAT score of chronic obstructive pulmonary disease patients with nosocomial infections

目的探讨慢性阻塞性肺疾病(COPD)患者医院感染临床特征及CAT评分对患者右心功能严重程度的评估价值,为COPD的诊疗提供参考。方法收集2012年5月-2015年8月医院收治的47例COPD患者临床资料,按照患者气流受限程度分为轻中度组29例,重度组18例,另选同期医院体检的健康人群50名作为对照组;收集医院感染患者临床资料,统计病原菌种类及耐药性;记录各组受试对象肺功能、CAT评分、心功能参数、血气分析指标,并分析CAT评分与右心功能的相关性。结果 47例COPD患者发生医院感染21例,医院感染率44.7%;共分离出39株病原菌,其中革兰阳性菌15株占38.5%,革兰阴性菌21株占53.8%,真菌3株占7.7%;轻中度组、重度组1s用力呼气容积(FEV1)、1s用力呼气容积/用力肺活量(FEV1/FVC)、氧分压(PaO2)、血氧饱和度(SpO2)显著低于对照组,二氧化碳分压(PaCO2)、右心室基底部横径(RVD)、右心房面积(RAA)、Tei指数、COPD评估测试量表(CAT)、肺动脉压(PAP)显著高于对照组(P<0.05),重度组FEV1、FEV1/FVC、SpO2PaO2、SpO2显著低于轻中度组,PaCO2、RVD、RAA、Tei指数、CAT、PAP显著高于轻中度组(P<0.05);轻中度组和重度组CAT评分均与FEV1、PaO2、SpO2呈负相关关系,与PaCO2、RVD、RAA、Tei指数、PAP呈正相关关系。结论革兰阴性菌是COPD医院感染病原菌的优势菌;CAT评分能够有助于评估COPD患者的右心功能严重程度,扩展CAT的应用范围。

OBJECTIVE To investigate the clinical characteristics of chronic obstructive pulmonary disease（COPD）patients with nosocomial infections and explore the value of CAT score in evaluation of severity of right heart function so as to provide guidance for diagnosis and treatment of COPD.METHODS The clinical data were collected from 47 COPD patients who were treated in the hospital from May 2012 to Aug 2015,then the patients were divided into the mild and moderate group with 29 cases and the severe group with 18 cases according to the degree of airflow limitation,meanwhile,50 healthy people who received the physical examination were chosen as the control group.The clinical data of the patients with nosocomial infections were collected,the distribution and drug resistance of the pathogens were statistically analyzed,the lung function,CAT score,cardiac function parameters,and blood gas analysis indicators of the study objects were recorded,and the correlation between the CAT score and the right heart function was observed.RESULTS Of the 47 patients with COPD,21 had nosocomial infections,with the infection rate 44.7%.A total of 39 strains of pathogens were isolated,including 15（38.5%）strains of gram-positive bacteria,21（53.8%）strains of gram-negative bacteria,and 3（7.7%）strains of fungi.The forced expiratory volume in 1second（FEV1）,forced expiratory volume in 1second/forced vital capacity（FEV1/FVC）,partial pressure of arterial oxygen（PaO2）,and saturation of peripheral oxygen（SpO2）were significantly lower in the mild and moderate group and the severe group than in the control group;however,the partial pressure of arterial carbon dioxide（PaCO2）,right ventricle base diameter（RVD）,right atrium area（RAA）,Tei index,COPD assessment table（CAT）,and pulmonary arterial pressure（PAP）were significantly higher in the mild and moderate group than in the control group（P〈0.05）.The FEV1,FEV1/FVC,PaO2,and SpO2 of the severe group were significantly lower than those of the mild and moderate group;the PaCO2,RVD,RAA,Tei index,CAT,and PAP were significantly higher in the severe group than in the mild and moderate group（P〈0.05）.The CAT score of the mild and moderate group and the severe group was negatively correlated with the FEV1,PaO2,and SpO2,while it was positively correlated with the PaCO2,RVD,RAA,Tei index,and PAP.CONCLUSION The gram-negative bacteria are dominant among the pathogens causing nosocomial infections in the COPD patients.The CAT score is conducive to the evaluation of the severity of right heart function of the COPD patients,and the application range of the CAT should be expanded.