呼吸科与ICU院内获得性肺炎预后影响因素分析

Analysis on the factors affecting prognosis for patients with hospital-acquired pneumonia in the department of respiratory medicine and intensive care unit

目的：分析呼吸科和ICU影响HAP预后的危险因素,以便采取有效的预防策略。方法：采取回顾性病例对照研究,收集2012年1月~2015年6月入院48 h后发生肺炎的患者资料,比较两科室患者的临床资料、基础疾病,采用卡方检验、Logistic回归方法对影响HAP预后的因素进行分析。结果：逐步logistic回归分析提示,影响呼吸科HAP预后的危险因素为年龄（OR=5.000）和恶性肿瘤（OR=11.571）,而ICU的危险因素为气管切开（OR=8.021）和近期重大手术史（OR=14.316）。结论：两科室院内获得性肺炎预后存在不同的危险因素,有效控制医院获得性肺炎的危险因素是降低HAP行之有效的措施。

Objective： To analyze the risk factors affecting prognosis for patients with hospital-acquired pneumonia（ HAP） from the department of respiratory medicine and intensive care unit（ ICU） of PLA 254 Hospital in order to plan effective strategies for prevention of this incidence. Methods： By retrospective case-control study,the clincal data were collected in patients complicated with HAP within 48 hours after admission to the two units aforementioned between January 2012 and June 2015. Then the risk factors affecting prognosis were analyzed based on the clinical baseline,underlying diseases with Chi-square test and Logistic regression modeling. Results： Stepwise Logistic regression analysis showed that the factors affecting the prognosis for patients of HAP from the department of respiratory medicine were associated with age（ OR = 5. 000） and presence of malignant tumor（ OR = 11. 571）,and those from ICU were involved in tracheotomy（ OR = 8. 021） and recent experience of major surgery（ OR = 14. 316）. Conclusion： Risk factors associated with poor prognosis exist in patients of HAP from either department of respiratory medicine or ICU,and management of these risks should be effective measures to reduce the incidence of HAP.