急性上消化道出血患者发生肺部感染的临床特点及危险因素分析

Analysis on the clinical characteristics and risk factors of pulmonary infection in patients with acute upper gastrointestinal bleeding

目的分析急性上消化道出血患者发生肺部感染的临床特点及危险因素,为临床诊疗提供参考。方法采用回顾性研究方法,选取2014年2月至2019年10月在黄冈市中心医院住院治疗的急性上消化道出血患者703例作为研究对象,依据是否发生肺部感染,分为合并肺部感染组(n=116)和非合并肺部感染组(n=587)。调查合并肺部感染组患者的病原菌分布,分析比较两组患者临床特点,Logistic回归分析急性上消化道出血患者发生肺部感染的影响因素。结果纳入的急性上消化道出血患者中,116例合并肺感染,占16.5%;合并肺部感染组患者分离出大肠埃希菌23株,铜绿假单胞菌22株,肺炎克雷伯菌12株,肺炎链球菌7株等。单因素分析显示合并肺部感染组患者在年龄≥60岁、意识障碍、休克、慢性阻塞性肺疾病方面高于非合并肺部感染组,差异均有统计学意义(P<0.05)。纳入上述单因素分析差异有统计学意义的指标为自变量构建Logistic多因素回归方程结果发现,年龄≥60岁、意识障碍、休克是肺部感染独立危险因素(P<0.05)。结论急性上消化道出血患者易发生肺部感染,年龄≥60岁、意识障碍及休克是急性上消化道出血患者发生肺部感染的危险因素。

Objective To analyze the clinical characteristics and risk factors of pulmonary infection in patients with acute upper gastrointestinal bleeding,so as to provide reference for clinical diagnosis and treatment.Methods A total of 703 patients with acute upper gastrointestinal bleeding who were hospitalized in Huanggang Central Hospital from February 2014 to October 2019 were selected as the study subjects of a retrospective study.They were divided into the combined pulmonary infection group(n=116)and the non-combined pulmonary infection group(n=587)based on whether they were suffering from pulmonary infection.The pathogenic bacteria distribution of patients in the combined pulmonary infection group was investigated,and the clinical characteristics of patients in both groups were analyzed and compared.The factors influencing the occurrence of pulmonary infection in patients with acute upper gastrointestinal bleeding were analyzed by logistic regression analysis.Results In all of the included patients with acute upper gastrointestinal bleeding,116 cases were combined with pulmonary infection,accounting for 16.5%.23 strains of Escherichia coli,22 strains of Pseudomonas aeruginosa,12 strains of Klebsiella pneumoniae,and 7 strains of Streptococcus pneumonia were isolated from the patients in the combined pulmonary infection group.Univariate analysis showed that the proportions of patients with age≥60 years,consciousness disorders,shock,and chronic obstructive pulmonary disease was higher in the combined pulmonary infection group than those in the non-combined pulmonary infection group,with statistically significant differences(P<0.05).A logistic multivariate regression equation was constructed by including the indicators with statistically significant differences in the above univariate analysis as independent variables,and the results showed that the age≥60 years,consciousness disorders and shock were the riskfactors of pulmonary infection(P<0.05).Conclusion Patients with acute upper gastrointestinal bleeding are prone to develop pulmonary infection,and age≥60 years,consciousness disorders and shock are risk factors for pulmonary infection in patients with acute upper gastrointestinal bleeding.