老年冠心病合并慢性阻塞性肺疾病医院感染影响因素分析

Analysis of the Influencing Factors of Nosocomial Infection in Elderly Patients with Coronary Heart Disease Complicated with Chronic Obstructive Pulmonary Disease

目的:分析探讨老年冠心病合并慢性阻塞性肺疾病医院感染影响因素。方法:选取笔者所在医院2017年11月-2019年11月收治的老年冠心病合并慢性阻塞性肺疾病患者200例进行研究,调查老年冠心病合并慢性阻塞性肺疾病医院感染影响情况,并对发生感染者痰液、血液、尿液进行分离培养。结果:感染以呼吸道为主,老年冠心病合并慢性阻塞性肺疾病200例患者中,医院感染54例,感染率27.00%。医院感染54例中检测出78株病原菌,分离出革兰阳性菌28株,占比35.90%,其中占比最多的是肺炎链球菌(12.82%,10株);分离出株真菌20株,占比为25.64%,其中占比最多是白色假丝酵母菌(17.95%,14株);革兰阴性菌30株,占比为38.46%,其中占比最多的是肺炎克雷伯菌(14.10%,11株);感染组与未感染组住院时间、性别、合并糖尿疾病、长期服用抗菌药物与是否侵入性操作差异有统计学意义(P<0.05),经过多因素Logistic回归分析后,长期服用抗菌药物、住院时间、合并糖尿疾病是导致老年COPD急性期合并肺部真菌感染的重要因素。结论:老年冠心病合并慢性阻塞性肺疾病主要以革兰阴性菌为主要病菌,预防医院内感染需要合理利用抗菌药物、执行预防措施,以减少院内感染率,从而保证医院环境健康。

Objective:To analyze the influencing factors of nosocomial infection in elderly patients with coronary heart disease complicated with chronic obstructive pulmonary disease.Method:A total of 200 elderly patients with coronary heart disease complicated with chronic obstructive pulmonary disease and who treated in our hospital from November 2017 to November 2019 were selected as the research,and the influencing factors of nosocomial infection in elderly patients with coronary heart disease complicated with chronic obstructive pulmonary disease were investigated.Then,the sputum,blood and urine were isolated and cultured.Result:The respiratory tract was the main cause of infection.In 200 cases of elderly patients with coronary heart disease complicated with chronic obstructive pulmonary disease,54 cases were nosocomial infection,and the infection rate was 27.00%.A total of 78 strains of pathogenic bacteria were detected in 54 cases of nosocomial infection,which 28 strains of Gram-positive bacteria were isolated,accounting for 35.90%,10 strains of Streptococcus Pneumoniae accounted for 12.82% of the total.A total of 20 fungi were isolated,accounting for 25.64%,which 14 were Candida Albicans,accounting for 17.95% at most.There were 30 Gram-negative bacteria,accounting for 38.46%,which 11 were Klebsiella Pneumoniae,accounting for 14.10%.There were significant differences in hospitalization time,gender,diabetes,long-term use of antibiotics and invasive operation between the infection group and the uninfected group (P<0.05).After multivariate Logistic regression analysis,long-term consumption of antibacterial drugs,hospital stay and diabetes were important factors leading to pulmonary fungal infection in elderly COPD patients at acute stage.Conclusion:The gram negative bacteria are the main pathogens in elderly patients with coronary heart disease complicated with chronic obstructive pulmonary disease,to prevent the risk of nosocomial infection,we need to make rational use of antibiotics and implement preventive measures,so as to reduce the impact rate of nosocomial infection and ensure the environmental health of the hospital.