老年冠心病患者医院获得性肺炎病原学特点

Etiological characteristics of hospital-acquired pneumonia in elderly patients with coronary heart disease

目的研究老年冠心病患者医院获得性肺炎病原学特点及相关危险因素。方法回顾性分析医院2016年11月-2017年11月收治冠心病患者(>60岁)740例临床资料,收集患者性别、年龄、冠心病类型、合并症、体重指数(Body Mass Index,BMI)、血清白蛋白、痰培养及药敏结果等临床资料进行影响因素分析。结果 740例冠心病患者根据是否发生医院获得性肺炎分为试验组(n=29)和对照组(n=711),医院获得性肺炎发生率为3.9%;29例医院获得性肺炎患者痰培养结果显示,共培养出致病菌37株,革兰阳性菌5株占13.51%,革兰阴性菌32株占86.49%;多因素分析结果显示,BMI<20kg/m^2、白蛋白<30g/L、糖尿病、COPD均为医院获得性肺炎的危险因素(P<0.05)。结论老年冠心病患者医院获得性肺炎致病菌以革兰阴性菌为主,老年冠心病患者医院获得性肺炎的危险因素较多,良好的营养支持及慢性病管理有利于预防医院获得性肺炎的发生。

OBJECTIVE To study the etiological characteristics and related risk factors of hospital-acquired pneumonia in elderly patients with coronary heart disease. METHODS The clinical data of 740 patients with coronary heart disease (over 60 years old) admitted to our hospital from Nov. 2016 to Nov. 2017 were retrospectively analyzed. The clinical data including gender, age, coronary heart disease type, comorbidity, body mass index (BMI), serum albumin, sputum culture and drug susceptibility results were analyzed, and the risk factors were summarized. RESULTS The 740 patients with coronary heart disease were divided into the experimental group (29 cases) and the control group (711 cases) according to the occurrence of hospital-acquired pneumonia. The incidence of hospitalacquired pneumonia was 3.9%. The sputum culture results of the 29 cases of hospital-acquired pneumonia patients showed that 37 strains of pathogens were co-cultured, with 5 strains of gram-positive bacteria accounting for 13.51 %, and 32 strains of gram-negative bacteria accounting for 86.49%. Multivariate analysis showed that BMI <20 kg/m^2 and albumin<30g/L, Diabetes and COPD were independent risk factors for hospital-acquired pneumonia (P<0.05). CONCLUSION The pathogens of hospital-acquired pneumonia in elderly patients with coronary heart disease are mainly gram-negative bacteria, and there are a number of risk factors for hospital-acquired pneumonia in elderly patients with coronary heart disease. Good nutritional support and chronic disease management are conducive to preventing the occurrence of hospital-acquired pneumonia.