老年吸入性肺炎患者病原菌感染特点及相关危险因素分析

Characteristics of pathogenic bacteria infection and related risk factors in elderly patients with aspiration pneumonia

目的分析老年吸入性肺炎患者病原菌感染特点及其相关危险因素,为临床有效防治老年吸入性肺炎提供依据。方法纳入2013年1月-2015年12月期间本院收治的需行机械通气治疗的老年患者120例,根据治疗过程中患者是否发生吸入性肺炎分为吸入性肺炎组(47例)和无吸入性肺炎组(73例)。分析吸入性肺炎组患者的病原菌分布情况及构成比;单因素分析吸入性肺炎的可能相关因素在两组间的差异,对单因素分析中存在显著差异的因素进行多元Logistic回归分析。结果 (1)47例吸入性肺炎患者中共检出病原菌96株,其中革兰阴性菌65株(67.7%)、革兰阳性菌20株(20.8%)、真菌11株(11.5%)。(2)单因素分析结果显示,两组间年龄、咳嗽反射障碍、意识障碍、长期卧床、吞咽障碍、胃食管反流、鼻饲饮食、低白蛋白血症、高血压、糖尿病、冠心病、口腔疾病等因素存在明显差异(P<0.05)。(3)多元Logistic回归分析结果显示,年龄≥70岁、咳嗽反射障碍、意识障碍、长期卧床、吞咽障碍、胃食管反流、鼻饲饮食、低白蛋白血症、高血压、冠心病均是吸入性肺炎的危险因素(P<0.05)。结论老年吸入性肺炎感染的病原菌主要以革兰阴性菌为主;年龄≥70岁、存在咳嗽反射障碍、意识障碍、长期卧床、吞咽障碍、胃食管反流、鼻饲饮食以及合并低白蛋白血症、高血压、冠心病等基础病的老年患者更易发生吸入性肺炎。

Objective To analyze the characteristics of pathogenic bacteria infection and related risk factors in elderly patients with aspiration pneumonia（AP）,and provide data for clinical prevention and treatment of elderly AP.Methods One hundred and twenty elderly patients with AP who needed mechanical ventilation were selected and divided into AP group（47cases）or non-AP group（73cases）.The distribution and proportion of pathogens in patients with AP were analyzed.The related factors of AP were analyzed and compared between the two groups.Finally,the related factors of AP with significant difference were analyzed by logistic analysis.Results（1）Ninety-six pathogens were isolated from the 47 AP patients,including 65 strains of Gram-negative bacteria（67.7%）,20 strains of Gram-positive bacteria（20.8%）,and 11 strains of fungi（11.5%）.（2）Single factor analysis showed that there were significant differences in age,cough reflex,disturbance of consciousness,long-term bedriddeness,dysphagia,gastroesophageal reflux,nasal feeding,hypoalbuminemia,hypertension,diabetes,coronary heart disease and oral disease between the two groups（Ps〈0.05）.（3）Logistic analysis showed that age≥70,cough reflex,disturbance of consciousness,long-term bedriddeness,dysphagia,gastroesophageal reflux,nasal feeding,hypoalbuminemia,hypertension and coronary heart disease were the risk factors of AP.Conclusion Elderly AP patients were usually infected by Gram-negative bacteria.Elderly patients at age of more than 70 suffering from cough reflex,disturbance of consciousness,long-term bedriddeness,dysphagia,gastroesophageal reflux,nasal feeding and underlying diseases such as hypoalbuminemia,hypertension and coronary heart disease are more prone to AP.