机械通气慢性阻塞性肺病患者腹泻危险因素及致病菌分析

Risk factors investigation and pathogenic analysis of diarrhea in patients with chronic obstructive pulmonary disease with mechanical ventilation

目的探讨进行机械通气的慢性阻塞性肺病(COPD)患者腹泻的危险因素及致病菌分析。方法回顾性分析自2015年1月至2018年1月四川大学华西医院收治的进行机械通气的COPD患者176例的临床资料。根据患者是否合并腹泻,将其分为腹泻组(n=68)与无腹泻组(n=108)。观察两组患者的临床特征,分析导致腹泻的危险因素及致病菌种类。结果腹泻组抗菌药物使用时间≥14 d、机械通气时间≥14 d、质子泵抑制剂使用≥14 d、急性生理学与慢性健康状况评分Ⅱ≥15分的患者比例均高于无腹泻组,组间比较,差异有统计学意义(P<0.05)。多因素分析结果显示,机械通气时间≥14 d、质子泵抑制剂使用时间≥14 d、抗菌药物使用时间≥14 d是进行机械通气的COPD患者腹泻的危险因素(P<0.05)。艰难梭状芽孢杆菌是导致机械通气的COPD患者腹泻的最常见的致病菌。结论进行机械通气的COPD患者腹泻发生率较高,抗菌药物使用时间≥14 d、机械通气时间≥14 d、质子泵抑制剂使用时间≥14 d是腹泻的危险因素,致病菌以艰难梭状芽孢杆菌最为常见。

Objective To investigate the epidemiological investigation and pathogenic analysis of diarrhea in patients with chronic obstructive pulmonary disease（ COPD） with mechanical ventilation. Methods A retrospective study was performed on 176 cases of patients with COPD who were given mechanical ventilation from January 2015 to January 2018. The patients were divided into the diarrhea group（ n = 68） and the non-diarrhea group（ n = 108） according to whether they had diarrhea. The clinical characteristics of the two groups of patients were observed and the risk factors of diarrhea and the types of pathogenic bacteria were analyzed. Results Compared with the non-diarrhea group,the antimicrobial drugs duration more than 14 days,mechanical ventilation duration more than14 days,proton pump inhibitors duration more than 14 days,acute physiology and chronic health conditions Ⅱ more than 15 points were all higher in the diarrhea group,and the difference was statistically significant between the groups（ P〈0. 05）. Multivariate analysis results showed that mechanical ventilation duration more than 14 days,proton pump inhibitor duration more than 14 days and antimicrobial drugs duration more than 14 days were risk factors for diarrhea in COPD patients undergoing mechanical ventilation（ P〈0. 05）. Clostridium difficile was the most common cause of diarrhea in mechanically ventilated COPD patients. Conclusion The chronic obstructive pulmonary disease patients with mechanical ventilation suffer from a higher rate of diarrhea,and antibacterial drugs duration more than 14 days,mechanical ventilation duration more than 14 days and proton pump inhibitors duration more than 14 days are risk factors of diarrhea. Clostridium difficile is the most common pathogenic bacteria.