老年患者开胸手术后下呼吸道感染的危险因素分析  

Risk factors for postoperative lower respiratory tract infections in elderly patients undergoing thoracotomy

作　　者：周灵云[1] 晏丽云[1] 张竞雄[1] 

机构地区：[1]杭州市第一人民医院胸外肾内科,浙江杭州310006

出　　处：《中华医院感染学杂志》2014年第9期2237-2238,2246,共3页Chinese Journal of Nosocomiology

基　　金：浙江省卫生厅一般规划基金项目(ZW-2010B-101027)

摘　　要：目的研究老年患者开胸手术后下呼吸道感染的危险因素及相应的干预对策,以期为临床防治感染提供参考依据。方法回顾性分析2009年10月-2012年10月300例老年开胸术后并发肺部感染患者的临床资料,将患者随机分为试验组和对照组,各150例;应用多因素logistic回归分析评价下呼吸道感染的危险因素,对照组应用常规干预护理,试验组采用针对感染危险因素制定的相应干预对策,观察两组患者干预前后肺感染评分情况。结果对300例感染患者经过单因素分析,排除次要的相关因素,对主要的相关因素经logistic回归分析,得出年龄、吸烟史≥10年、留置鼻胃管、显著排痰困难、慢性支气管炎病史、慢性肺气肿病史、双腔气管插管、术后应用呼吸机≥6h为下呼吸道感染的危险因素(P<0.05);干预前两组患者CPIS评分无差异,干预后试验组评分中体温为(0.87±0.08)分、白细胞计数为(0.79±0.21)分、分泌物为(1.02±0.13)分、气体交换指数为(0.65±0.36)分、X线胸片浸润影为(0.92±0.03)分,对照组分为(1.32±0.26)、(1.24±0.35)、(1.36±0.23)、(1.14±0.08)、(1.23±0.09)分,两组比较差异有统计学意义(P<0.05)。结论老年患者开胸手术后下呼吸道感染是多因素作用的结果,临床防治感染应针对患者自身情况进行相应的干预护理。OBJECTIVE To study the risk factors for postoperative lower respiratory tract infections in elderly patients undergoing thoracotomy and put forward corresponding intervention measures so as to provide guidance for clinical prevention and treatment of infections.METHODS A total of 300elderly patients complicated with pulmonary infections,who were underwent the thoracotomy from Oct 2009to Oct 2012,were enrolled in the study and randomly divided into the experimental group and the control group,with 150cases in each group,then the clinical data were retrospectively analyzed,the risk factors for the lower respiratory tract infections were analyzed by means of the multivariate logistic regression analysis,the control group was treated with conventional nursing intervention,the experimental group was given the corresponding intervention countermeasures in response to the risk factors,and the score of pulmonary infections was observed before and after the intervention.RESULTS The minor related factors for infections in the 300patients were ruled out through the univariate analysis;the logistic regression analysis showed that the age,history of smoking no less than 10years,nasogastric tube indwelling,remarkable expectoration difficulties,history of chronic bronchitis,history of chronic emphysema,double-lumen endotracheal intubation,and postoperative use of ventilator no less than 6hours were the risk factors for the lower respiratory tract infections（P＆lt;0.05）.Before the intervention,the difference in the CPIS between the two groups was not significant.After the intervention,the score of body temperature was（0.87±0.08）points in the experimental group,（1.32±0.26）points in the control group;the score of white blood cells counts was（0.79±0.21） points in the experimental group,（1.24±0.35）points in the control group;the score of secretions was（1.02 ±0.13）points in the experimental group,（1.36±0.23）points in the control group;the score of gas exchange index was（0.65±0.36）points in the

关 键 词：老年患者 开胸手术 下呼吸道感染 干预对策 

分 类 号：R563[医药卫生—呼吸系统]