老年急性心肌梗死患者医院获得性肺炎相关因素分析

Factors for hospital acquired pneumonia in elderly acute myocardial infarction patients

目的分析老年急性心肌梗死患者医院获得性肺炎的相关影响因素。方法选择2015年1月~2019年1月贵州医科大学第三附属医院感染管理科住院的老年急性心肌梗死患者2171例,调查患者临床资料及其分离出的病原菌种类等情况,对其合并医院获得性肺炎相关因素进行单因素和多因素logistic回归分析。结果2171例患者中,发生医院获得性肺炎132例(6.08%)。共检出病原菌株126株,其中革兰阳性球菌24株(19.05%),革兰阴性杆菌86株(68.25%),真菌16株(12.70%),前5位菌种分别为大肠埃希菌、白色念珠菌、鲍曼不动杆菌、肺炎克雷伯菌、金黄色葡萄球菌。单因素分析显示,年龄、住院天数、长期吸烟、慢性肺部疾病、糖尿病、心功能分级、侵入操作、病程、卧床时间、意识状态、受凉、C反应蛋白、血糖、降钙素原为老年急性心肌梗死合并医院获得性肺炎的危险因素(P<0.05,P<0.01);服用他汀类药物和PCI术是老年急性心肌梗死合并医院获得性肺炎的保护因素(P<0.01)。多元logistic回归分析显示,心功能分级、侵入操作、卧床、昏迷、降钙素原是老年急性心肌梗死合并医院获得性肺炎的独立危险因素,服用他汀类药物和PCI术是老年急性心肌梗死合并医院获得性肺炎的独立保护因素(P<0.05,P<0.01)。结论保护心功能,减少不必要的侵入性操作,早期下床,重点关注昏迷患者病情变化,使用他汀类药物,根据适应证采取PCI术可减少医院获得性肺炎发生;监测降钙素原可作观测因素。

Objective To analyze the factors for hospital acquired pneumonia in elderly acute myocardial infarction(AMI)patients.Methods A total of 2171 elderly AMI patients admitted to our hospital from January 2015 to January 2019 were included in this study.Their clinical data and isolated pathogens were recorded.The factors for hospital acquired pneumonia were analyzed by univariate logistic regression analysis and multivariate logistic regression analysis respectively.Results Of the 2171 AMI patients,132(6.08%)were diagnosed with hospital acquired pneumonia with 126 pathogenic strains detected,including 24 strains of Gram-positive bacteria(19.05%),86 strains of Gram-negative bacteria(68.25%),and 16 strains of fungus(12.70%).The top 5 strains were Escherichia coli,Candida albicans,Acinetobacter baumannii,Klebsiella pneumoniae,Staphylococcus aureus.Univariate logistic regression analysis showed that age,hospital stay time(days),long history of smoking,chronic lung disease,DM,cardiac function,invasive procedures,disease duration,bed rest,consciousness state,cold,serum levels of CRP,blood glucose and procalcitonin were the risk factors while administration of atorvastatin and PCI were the protective factors for hospital acquired pneumonia in elderly AMI patients(P<0.05,P<0.01).Multivariate logistic regression analysis showed that cardiac function,invasive procedures,bed rest,coma and serum procalcitonin level were the independent risk factors while administration of atorvastatin and PCI were the protective factors for hospital acquired pneumonia in elderly AMI patients(P<0.05,P<0.01).Conclusion The incidence of hospital acquired pneumonia can be reduced by protecting the heart function,reducing the unnecessary invasive procedures,shortening the bed rest time,focusing on the conditions of coma patients,using lipid-regulating statins,and performing PCI.Procalcitonin monitoring can be used as an observation factor.