老年心力衰竭患者合并肺部感染及预后影响因素

Pulmonary infection in elderly patients with heart failure and influencing factors for prognosis

目的分析心力衰竭(HF)合并肺部感染老年患者病原菌分布及预后影响因素。方法选择2015年1月-2019年12月遵义市第一人民医院收治的100例HF合并肺部感染老年患者作为感染组,选择同期收治的100例HF未合并肺部感染老年患者作为对照组。对感染组患者采集痰液标本进行病原菌鉴定,分析并筛选老年HF患者合并肺部感染的影响因素。比较两组住院治疗效果,并分析老年HF患者合并肺部感染预后不良的影响因素。结果 100例HF合并肺部感染患者共分离出病原菌112株,其中革兰阴性菌62株(55.36%),革兰阳性菌44株(39.29%),真菌6株(5.36%);年龄、心功能分级、吸烟史、糖尿病、合并呼吸道疾病、侵入性操作及卧床时间是老年HF患者合并肺部感染的影响因素;感染组治疗后预后良好(显效+有效)患者占比(78.00%)显著低于对照组(94.00%),两组比较差异有统计学意义(χ^(2)=2.680,P=0.007),住院时间较对照组显著延长(t=10.631,P<0.001);单因素分析及多因素Logistic回归分析结果显示,年龄、心功能分级、合并呼吸道疾病是老年HF合并肺部感染患者预后不良的影响因素。结论老年HF患者合并肺部感染的主要病原菌为革兰阴性菌,需针对影响因素,积极控制高危患者的病情进展,改善患者预后。

OBJECTIVE To investigate the distribution of pathogens isolated from the elderly heart failure(HF) patients complicated with pulmonary infection and observe the influencing factors for prognosis. METHODS Totally 100 elderly HF patients complicated with pulmonary infection who were treated in the First People′s Hospital of Zunyi from Jan 2015 to Dec 2019 were assigned as the infection group, meanwhile, 100 HF patients without pulmonary infection were chosen as the control group.The sputum specimens were collected from the patients with infection, the isolated pathogens were identified.The curative effects were compared between the two groups, and the influencing factor for the poor prognosis of the elderly HF patients complicated with pulmonary infection were analyzed. RESULTS A total of 112 strains of pathogens were isolated from the 100 HF patients complicated with pulmonary infection, 62(55.36%) of which were gram-negative bacteria, 44(39.29%) were gram-positive bacteria, and 6(3.70%) were fungi.The age, cardiac function classification, smoking history, diabetes mellitus, complication with respiratory diseases, invasive operation and bedridden time were the influencing factors for the pulmonary infection in the elderly HF patients.The percentage of the patients who had favorable prognosis(markedly effective plus effective) was 78.00% in the infection group after the treatment, significantly lower than 94.00% in the control group(χ^(2)=2.680,P=0.007);the length of hospital stay of the infection group was significantly longer than that of the control group(t=10.631,P<0.001).The results of univariate analysis and multivariate logistic regression analysis indicated that the age, cardiac function classification and complication with respiratory diseases were the influencing factors for the poor prognosis of the elderly HF patients complicated with pulmonary infection. CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from the elderly HF patients complicated with pulmonary infection, and it is necessary to actively control the progression of illness condition of the high risk patients according to the influencing factors so as to improve the prognosis.