老年糖尿病医院获得性肺炎流行病学和营养状况及其预后

Epidemiological characteristics of hospital-acquired pneumonia,nutritional status,and prognosis of elderly hospitalized patients with diabetes mellitus

目的探讨老年糖尿病住院患者医院获得性肺炎(HAP)的流行病学特征和营养状况、免疫功能及其预后。方法选取2016年1月-2018年12月老年糖尿病住院患者430例,调查HAP发生率、病原学分布特征,进行微型营养评定(MNA),检查患者的营养生化指标、免疫功能指标及其预后。结果430例糖尿病老年住院患者发生HAP 66例,发生率为15.35%,66例HAP均进行痰标本培养,痰培养病原菌阳性38例(57.58%),共分离病原菌45株,主要为肺炎克雷伯菌12株占26.67%,鲍氏不动杆菌7株占15.56%,金黄色葡萄球菌7株占15.56%,肺炎链球菌5株占11.11%;HAP组患者年龄大于非HAP组(P<0.05),使用广谱抗生素、使用糖皮质激素、气管侵入性操作、肺部原发病、排痰不畅或误吸、意识障碍的比例均高于非HAP组(P<0.05);HAP组MNA营养评分(18.78±3.59)分,低于非HAP组(P<0.05);HAP组患者营养状况指标血清白蛋白、前白蛋白、转铁蛋白水平均低于非HAP组(P<0.05);免疫功能指标淋巴细胞计数、免疫球蛋白G水平均低于非HAP组(P<0.05);430例患者经治疗后,好转423例(98.37%),死亡7例(1.63%),HAP患者的病死率高于非HAP患者(P<0.05)。结论糖尿病老年住院患者医院获得性肺炎受多种因素影响,其中营养不良是导致HAP的重要原因,临床上应重视患者的营养支持治疗,提高患者免疫功能,从而降低HAP感染率及病死率。

OBJECTIVE To explore the epidemiological characteristics of hospital-acquired pneumonia(HAP),nutritional status,immune function and prognosis of elderly hospitalized patients with diabetes mellitus.METHODS A total of 430 elderly patients with diabetes mellitus who were hospitalized from Jan 2016 to Dec 2018 were enrolled in the study.The incidence of HAP and distribution of pathogens were investigated,the mini nutritional assessment(MNA)was performed,and the nutritional biochemical indexes,immune function indexes and prognosis of the patients were detected.RESULTS Of 430 elderly hospitalized patients with diabetes mellitus,66 had HAP,with the incidence rate 15.35%.The sputum specimens were cultured for all the 66 patients with HAP,and 38(57.58%)were tested positive.Totally 45 strains of pathogens were isolated,12(26.67%)of which were Klebsiella pneumoniae,7(15.56%)were Acinetobacter baumannii,7(15.56%)were Staphylococcus aureus,and 5(11.11%)were Streptococcus pneumoniae.The patients with HAP were significantly older than the patients without HAP(P<0.05).The proportions of the patients with use of broad-spectrum antibiotics,use of glucocorticoids,intratracheal invasive operation,pulmonary primary disease,poor expectoration or aspiration,and disturbance of consciousness were significantly higher in the HAP group than in the non-HAP group(P<0.05).The MNA score of the HAP group was(18.78±3.59)points,significantly lower than that of the non-HAP(P<0.05).The levels of nutritional status indexes serum albumin,prealbumin and transferrin of the HAP group were significantly lower than those of the non-HAP group(P<0.05).The levels of immune function indexes lymphocyte counts and immunoglobulin G of the HAP group were significantly lower than those of the non-HAP group(P<0.05).Among the 430 patients,423(98.37%)were improved after the treatment,and 7(1.63%)died;the mortality rate of the patients with HAP was significantly higher than that of the patients without HAP(P<0.05).CONCLUSION There are a variety of influencing factors for the hospital-acquired HAP in the elderly hospitalized patients,and malnutrition is a leading cause of the pulmonary infection.It is necessary for the hospital to conduct nutrition support therapy and boost the immune function so as to reduce the incidence of HAP as well as the mortality rate.