老年血管性痴呆患者并发肺部感染的影响因素及临床特点分析

Analysis of influencing factors and clinical characteristics of pulmonary infection in elderly patients with vascular dementia

目的探讨老年血管性痴呆(VaD)患者并发肺部感染的影响因素及临床特点。方法老年VaD患者164例,其中并发肺部感染80例(感染组),未并发肺部感染84例(无感染组)。收集两组患者的临床资料,采用多因素logistic回归分析老年VaD患者并发肺部感染的影响因素,分析老年VaD患者并发肺部感染的临床特点。结果与无感染组比较,感染组日常生活能力量表评分较低,吸烟、合并糖尿病、重度痴呆、长期卧床、营养不良、低白蛋白血症、意识障碍、吞咽功能障碍和侵袭性操作比例较高(P<0.05)。吸烟、合并糖尿病、重度痴呆、低白蛋白血症和侵袭性操作是老年VaD患者并发肺部感染的独立危险因素(P<0.05)。感染组中,65例(81.25%)患者以咳嗽、咳痰、气促和喘息等呼吸道症状为首发症状,71例(88.75%)患者肺部可闻及湿啰音、哮鸣音,37例(46.25%)患者白细胞计数正常。80例肺部感染患者中,轻度24例,中度47例,重度9例。共检出病原菌26株,其中大肠杆菌9株,铜绿假单胞菌8株。结论吸烟、合并糖尿病、重度痴呆、低白蛋白血症和侵袭性操作是老年VaD患者并发肺部感染的独立危险因素。老年VaD患者并发肺部感染的病原菌可能以革兰阴性杆菌为主,患者不一定具有典型的临床症状、体征和实验室检查结果。

Objective To investigate the influencing factors and clinical characteristics of pulmonary infection in elderly patients with vascular dementia(VaD).Methods A total of 164 patients with VaD were divided into two groups of A(complicated with pulmonary infection,80 cases)and B(without pulmonary infection,84 cases).The clinical data of the two groups were collected.Multivariate logistic regression was used to analyze the influencing factors of pulmonary infection in elderly patients with VaD.The clinical characteristics of elderly VaD patients complicated with pulmonary infection were analyzed.Results Compared with group B,group A had lower activity of daily living scale score,and higher percentages of smoking,diabetes mellitus,severe dementia,long-term bed rest,malnutrition,hypoalbuminemia,disturbance of consciousness,swallowing dysfunction,and invasive procedures(P<0.05).Smoking,diabetes mellitus,severe dementia,hypoalbuminemia and invasive procedures were the independent risk factors for pulmonary infection in elderly patients with VaD(P<0.05).In group A,65 patients had respiratory symptoms such as cough,phlegm,shortness of breath and wheezing as the first symptom,71 patients had moist rales and wheezing rales,and white blood cell count was normal in 37 patients.Of 80 patients with pulmonary infection,24 cases were mild,47 cases were moderate,and 9 cases were severe.A total of 26 strains of pathogenic bacteria were detected in 80 patients,including 9 strains of Escherichia coli and 8 strains of Pseudomonas aeruginosa.Conclusion Smoking,diabetes mellitus,severe dementia,hypoalbuminemia,and invasive procedures are the independent risk factors for pulmonary infection in elderly patients with VaD.The main pathogens of pulmonary infection are Gram-negative bacteria,and the patients do not necessarily have typical clinical symptoms,signs and laboratory results.