尿毒症患者医院获得性肺炎临床特点与易患因素分析  

Clinical characteristics of hospital-acquired pneumonia in uremia patients and analysis of risk factors

作　　者：刘广建[1] 陈晓阳[1] 陈锦海[1] 

机构地区：[1]福建医科大学附属第二医院肾内科,福建泉州362000

出　　处：《中华医院感染学杂志》2015年第1期139-141,共3页Chinese Journal of Nosocomiology

基　　金：福建省人力资源和社会保障厅留学人员科技活动择优基金资助项目(FJTPC2010007)

摘　　要：目的观察尿毒症患者医院获得性肺炎(HAP)的临床特点,分析其易患因素,为临床防治提供参考。方法回顾性分析2008年1月-2012年12月430例尿毒症住院患者的临床资料,观察HAP发生率、年龄、病原学特点,通过多因素logistic分析其HAP易患因素。结果 430例尿毒症患者中发生HAP32例,发生率7.4%;共培养病原菌25株,其中革兰阴性菌19株占76.0%,13株为多药耐药(MDR)菌,革兰阳性菌为6株占24.0%,2株为MDR;肺炎双球菌和金黄色葡萄球菌对青霉素、氨苄西林、红霉素完全耐药,未发现万古霉素的耐药株,主要革兰阴性菌对美罗培南较敏感,耐药率<25.0%;多因素logistic回归分析结果显示,住院时间>5d、接受维持性血液透析、血清白蛋白<30g/L、年龄>60岁是发生HAP的独立危险因素。结论缩短患者住院时间,加强营养支持治疗,规范血液透析管理,提高病原菌检出率,根据致病菌培养特点早期、合理使用抗菌药物等有助于尿毒症患者HAP的防治。OBJECTIVE To observe the clinical characteristics of hospital-acquired pneumonia （HAP）in uremia pa-tients and analyze the risk factors so as to provide guidance for the clinical prevention and treatment.METHODS The clinical data of 430 uremia patients who were hospitalized from Jan 2008 to Dec 2012 were retrospectively ana-lyzed,the incidence of HAP,age,and etiological characteristics were observed,and the multivariate logistic anal-ysis was performed for the risk factors for HAP.RESULTS The HAP occurred in 32 of 430 uremia patients with the incidence rate of 7.4%.A total of 25 strains of pathogens have been cultured,including 19 （76.0%）strains of gram-negative bacteria and 6 （24.0%）strains of gram-positive bacteria;there were 13 strains of multidrug-resist-ant gram-negative bacteria and 2 strains of multidrug-resistant gram-positive bacteria. The Pneumococci and Staphylococcusaureus were completely resistant to penicillin,ampicillin,and erythromycin,while no strain resist-ant to vancomycin was found;the drug resistant rate of the main gram-negative bacteria to meropenem was less than 25.0%.The results of the multivariate logistic regression analysis indicated that the length of hospital stay more than 5 days,acceptance of maintenance hemodialysis,albumin level less than 30 g/L,and more than 60 years of age were the independent risk factors for HAP.CONCLUSION It is an effective way to shorten the length of hospital stay,intensify the nutritional support therapy,standardize the management of hemodialysis,raise the isolation rate of pathogens,and reasonably use antibiotics in early stage on the basis of characteristics of culture of pathogens so as to prevent HAP in the uremia patients.

关 键 词：医院获得性肺炎 易患因素 尿毒症 

分 类 号：R563.1[医药卫生—呼吸系统]