老年心力衰竭患者发生肺部感染临床特点及预防研究

Clinical characteristics and prevention of lung infection in elderly patients with heart failure

目的探讨老年心力衰竭患者发生肺部感染的危险因素、常见致病菌及耐药性,提出相应预防和治疗对策,降低心力衰竭患者并发肺部感染的发生率。方法选取2014年9月-2015年12月收治的心力衰竭患者1184例,对患者基本资料进行统计,分析患者肺部感染率,取感染患者痰液或下呼吸道分泌物进行细菌培养并行耐药性分析。结果 1 184例心力衰竭患者发生肺部感染99例,肺部感染率为8.36%;患者年龄>70岁、心功能IV级、合并呼吸道疾病及糖尿病是发生肺部感染的相关因素,差异有统计学意义(P<0.05);肺部感染患者中共检出病原菌132株,其中革兰阴性菌82株占62.12%,革兰阳性菌33株,占25.00%,真菌17株,占12.88%;革兰阴性菌对阿米卡星和环丙沙星耐药率较高,分别达39.02%和36.59%,而对哌拉西林/他唑巴坦耐药率较低,仅为15.85%;革兰阳性菌对头孢唑林、青霉素和红霉素耐药率较高,分别达100.00%、90.91%和84.85%,对利奈唑胺无耐药性,对万古霉素耐药率仅为3.03%。结论老年心力衰竭患者并发肺部感染与多种因素有关,临床医疗与护理服务过程中应给与针对性的关注;一旦发生感染,早期可给与经验性联合应用抗菌药物,并根据病原学和耐药性检查及时调整抗菌药物。

OBJECTIVE To discuss the risk factors,common pathogens and drug resistance lung infection in elderly patients with heart failure,so as to provide prevention and treatment measures to reduce heart failure patients the incidence of pulmonary infection.METHODS A total of 1 184 cases of patients with heart failure in our hospital from Sep.2014 to Dec.2015 were selected,whose basic information was under statistical analysis to know the infection rate of pulmonary infection.Infected sputum or lower respiratory tract secretions were taken for bacterial culture parallel analysis of drug resistance.RESULTS From the 1 184 cases,there were 99 cases of patients with pulmonary infection,pulmonary infection rate 8.36%.Age group〉 70 years,class IV heart function,respiratory disease and diabetes combined were relevant factors for pulmonary infection,and the difference was statistically significant（P〈0.05）.From 99 cases of pulmonary infection 132 strains of pathogens were detected,including gram-negative bacteria detected in 82 strains,accounting for 62.12%,gram-positive bacteria detected in 33 strains,accounting for 25.00%,fungal detected in 17 strains,accounting for 12.88%.Drug resistance of gramnegative bacteria to ciprofloxacin and amikacin generally higher reached to 39.02% and 36.59%,but to piperacillin/tazobactam resistance rates were low,only 15.85%.Drug resistance rates of gram-positive bacteria to general cefazolin,penicillin and erythromycin were higher,reaching 100.00%,90.91% and 84.85%,but non-resistance to linezolid,and only 3.03% to vancomycin.CONCLUSION The incidence of elderly patients with heart failure complicated with lung infection has a variety of factors,in the clinical care process special attention should be given.Once the infection occurs,antibiotics could be used combined as experience told at the beginning,and according to the etiology and drug resistance to check and adjust antibiotics.