老年冠心病合并心衰患者医院肺部感染危险因素分析及预防对策

Risk Factors and Preventive Measures of Nosocomial Pulmonary Infection in Elderly Patients with Coronary Heart Disease Complicated with Heart Failure

目的:探讨老年冠心病合并心衰患者医院肺部感染危险因素及预防对策。方法:对我院2015年5月~2018年4月的1828例老年冠心病合并心衰患者临床资料进行回顾性分析。结果:1828例老年冠心病合并心衰患者中,有43例发生肺部感染。单因素分析发现,患者吸烟史、糖尿病病史、住院时间、营养状态、侵入性操作、吞咽障碍、长期卧床情况和冠心病病史对患者的肺部感染发生率有显著影响,而性别对患者的肺部感染发生率无显著影响;多因素Logistic分析结果显示,吸烟史、糖尿病病史、住院时间、营养状态差、侵入性操作、吞咽障碍和长期卧床是影响老年冠心病合并心衰患者发生肺部感染的独立危险因素。结论:老年冠心病合并心衰患者发生医院肺部感染与吸烟史、糖尿病病史、住院时间、营养状态差、侵入性操作、吞咽障碍和长期卧床有关。通过加强病房消毒、建立完善的环境监测体系,戒烟、早期营养支持,治疗过程中严格无菌操作、减少侵入性操作和合理使用抗菌药物,可降低或避免老年冠心病合并心衰患者医院肺部感染的发生。

Objective:To explore the risk factors and preventive measures of nosocomial pulmonary infection in elderly patients with coronary heart disease complicated w ith heart failure.Method:The clinical data of 1828 elderly patients w ith coronary heart disease and heart failure from M ay 2015 to April 2018 in our hospital w ere retrospectively analyzed.Result:There w ere 43 cases of pulmonary infection in 1828 elderly patients w ith coronary heart disease complicated w ith heart failure.Univariate analysis show ed that smoking history,history of diabetes mellitus,hospitalization time,nutritional status,invasive procedures,dysphagia,long-term bed rest and the history of coronary heart disease had significant effects on the incidence of pulmonary infection,w hile gender had no significant effect on the incidence of pulmonary infection.M ultivariate logistic analysis show ed that smoking history,history of diabetes mellitus,hospitalization time,poor nutritional status,invasive procedures,dysphagia and long-term bed rest w ere independent risk factors for pulmonary infection in elderly patients w ith coronary heart disease complicated w ith heart failure.Conclusion:Nosocomial pulmonary infection in elderly patients w ith coronary heart disease complicated w ith heart failure w as related to smoking history,history of diabetes mellitus,hospitalization time,poor nutritional status,invasive procedures,dysphagia and long-term bed rest.The occurrence of nosocomial pulmonary infection in elderly patients w ith coronary heart disease complicated w ith heart failure can be reduced or avoided by strengthening w ard disinfection,establishing perfect environmental monitoring system,quitting smoking,early nutritional support,strict aseptic operation during treatment,reducing invasive operation and rational use of antibiotics.