老年高血压合并心肌梗死患者PCI术后发生肺部感染的危险因素分析

Risk factors of pulmonary infection in elderly patients with hypertension complicated with myocardial infarction after PCI

目的:分析老年高血压合并心肌梗死(MI)患者经皮冠状动脉介入(PCI)术后发生肺部感染的危险因素.方法:选取2021年1月—2022年12月在洪湖市中医医院接受PCI治疗的老年高血压合并MI患者130例,收集患者一般及临床资料.依据患者PCI术后是否发生肺部感染进行分组,分析患者PCI术后发生肺部感染的危险因素,采用受试者工作特征(ROC)曲线评估预测效能.结果:130例老年高血压合并MI患者中,PCI术后发生肺部感染29例,发生率为22.31%.感染组和未感染组患者在年龄、Killip分级、卧床时间、侵入性操作及是否合并糖尿病、慢性阻塞性肺疾病(COPD)方面比较,差异均有统计学意义(P<0.05).多因素Logistic回归分析结果显示,年龄≥75岁、Killip分级Ⅲ~Ⅳ级、卧床时间≥14 d、有侵入性操作、合并糖尿病、合并COPD是老年高血压合并MI患者PCI术后发生肺部感染的危险因素(P<0.05).ROC曲线显示,该模型预测老年高血压合并MI患者PCI术后发生肺部感染的曲线下面积为0.879[95%CI(0.824,0.943)],敏感度、特异度分别为0.839、0.787,提示模型区分度较好.结论:老年高血压合并MI患者PCI术后发生肺部感染的危险因素较多,包括年龄、Killip分级、卧床时间、侵入性操作、合并糖尿病、合并COPD等,据此可用于预测肺部感染的发生,及早进行干预.

Objective To analyze the risk factors of pulmonary infection in elderly patients with hypertension complicated by myocardial infarction(MI)after percutaneous coronary intervention(PCI).Methods A total of 130 elderly patients with hypertension combined with MI who received PCI treatment in Honghu Hospital of Traditional Chinese Medicine from January 2021 to December 2022 were selected.Medical records of the patients were consulted,and general and clinical data of the patients were collected.Patients were grouped according to whether they developed pulmonary infection after PCI,the risk factors of pulmonary infection after PCI were analyzed.The prediction efficiency was evaluated by receiver operating characteristics(ROC)curve.Results Among 130 elderly patients with hypertension combined with MI,29 cases of pulmonary infection occurred after PCI,with an incidence of 22.31%.There were statistically significant differences between infected and uninfected patients in age,Killip grade,bed duration,invasive procedure,diabetes and chronic obstructive pulmonary disease(COPD)(P<0.05).Multivariate Logistic regression analysis showed that age≥75 years old,Killip gradeⅢ-Ⅳ,bed duration≥14 days,invasive operation,diabetes mellitus and COPD were the risk factors for pulmonary infection in elderly patients with hypertension and MI after PCI(P<0.05).The ROC curve showed that the area under the curve of this model to predict pulmonary infection in elderly patients with hypertension combined with MI after PCI was 0.879[95%CI(0.824,0.943)],and the sensitivity and specificity were 0.839 and 0.787,respectively,indicating a good model differentiation.Conclusions There are many risk factors for pulmonary infection in elderly patients with hypertension combined with MI after PCI,including age,Killip grade,bed time,invasive operation,combined with diabetes,combined with COPD,etc.This can be used to predict the occurrence of pulmonary infection and early intervention.