老年患者发生吸入性肺炎的相关因素分析与对策  

Risk factors for aspiration pneumonia in elderly patients and countermeasures

作　　者：王晓华[1] 高燕飞[1] 王秋燕[1] 章妙玉[1] 陈静[1] 钟玲玲[1] 

机构地区：[1]浙江省立同德医院干部保健科,浙江杭州310012

出　　处：《中华医院感染学杂志》2014年第5期1161-1162,1165,共3页Chinese Journal of Nosocomiology

基　　金：浙江省卫生厅基金项目(2013KYA162)

摘　　要：目的探讨老年患者发生吸入性肺炎的相关危险因素和干预措施,以期为预防与治疗老年患者吸入性肺炎的发生提供依据。方法收集2009年1月-2012年12月876例老年患者临床资料,分析吸入性肺炎发生情况,进行相关影响因素的调查,行logistic多因素分析危险因素,并根据相关危险因素采取有针对性的干预措施。结果 876例老年患者有11例发生吸入性肺炎,发生率为13.36%;共分离革兰阴性杆菌69株占58.98%,革兰阳性球菌37株占31.62%,真菌11株占9.40%;单因素χ2检验发现,吸入性肺炎与年龄、患有基础疾病、意识障碍、体位不当、胃食管反流、吞咽困难、反复吸痰、鼻饲饮食等因素相关;logistic多因素回归分析发现高龄(OR=4.716,P=0.026)、合并基础疾病(OR=5.368,P=0.032)、胃食管反流(OR=2.862,P=0.015)和意识障碍(OR=2.737,P=0.022)是吸入性肺炎发生的独立危险因素。结论吸入性肺炎发生与多种因素有关,应根据相应的情况,采取针对性的干预措施,密切监测高龄患者病情,加强对患者心理、饮食以及气道管理,预防吸入性肺炎的发生。OBJECTIVE To explore the risk factors for aspiration pneumonia in elderly patients and put forward nursing interventions so as to provide guidance for prevention and treatment of the aspiration pneumonia. METHODS The clinical data of 876 elderly patients who were hospitalized from Jan 2009 to Dec 2012 were collected, then the incidence of aspiration pneumonia was analyzed, the influencing factors were investigated, the multivariate logistic regression analysis of the risk factors was performed, and the targeted intervention measures were taken according to the related risk factors. RESULTS The aspiration pneumonia occurred in 11 of 876 elderly patients with the incidence of 13.36%. There were 69 （58.98%） strains of gram-negative bacilli, 37 （31. 62%） strains of gram-positive cocci, and 11 （9.40%） strains of fungi. The univariate chi-square test indicated that the aspiration pneumonia was related to the age, underlying disease, disturbance of consciousness, improper posture, gastroesophageal reflux, dysphagia, repeated sputum suction, or nasal feeding; the multivariate logistic regression analysis showed that the advanced age （OR=4. 716,P=0. 026）, complication of underlying disease （OR=5. 368,P=0. 032）, gastroesophageal reflux （OR=2. 862,P=0. 015） and disturbance of consciousness （OR=2. 737,P = 0. 022） were the independent risk factors for the aspiration pneumonia. CONCLUSION The incidence of aspiration pneumonia is related to many risk factors; it is necessary to take targeted intervention measures, closely monitor the condition of the aged patients, and strengthen the psychological nursing and guiding of diet as well as the airway management so as to prevent the aspiration pneumonia.

关 键 词：吸入性肺炎 老年患者 危险因素 干预对策 

分 类 号：R563.1[医药卫生—呼吸系统]