慢性阻塞性肺疾病合并呼吸衰竭患者肺部铜绿假单胞菌感染危险因素分析  

Risk factors of lung infection caused by Pseudomonas aeruginosa in patients with acute exacerbation of chronic obstructive pulmonary disease

作　　者：巫亚颖[1] WU Ya-ying(Department of Emergency, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China)

机构地区：[1]上海中医药大学附属岳阳中西医结合医院急诊科,上海200437

出　　处：《中国医学前沿杂志（电子版）》2017年第6期59-63,共5页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

摘　　要：目的探讨慢性阻塞性肺疾病(chronic obstructive pulmonary diseases,COPD)合并呼吸衰竭患者肺部铜绿假单胞菌感染的危险因素。方法选取2015年1月至2016年12月本院收治的COPD合并呼吸衰竭患者198例为研究对象,根据患者是否发生肺部铜绿假单胞菌感染,将其分为感染组(37例)和非感染组(161例)。收集患者住院期间主要临床特征,包括病情严重程度[第一秒用力呼气量(forced expiratory volume in first second,FEV_1)占预计值百分比(FEV_1%预计值)、动脉血氧分压(partial pressure of oxygen,PaO_2)、动脉血二氧化碳分压(partial pressure of carbon dioxide,PaCO_2)、急性生理与慢性健康状况Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分及是否合并肺心病]和临床干预情况[是否气管插管、是否双相持续气道正压(bilevel positive airway pressure,Bi PAP)通气、辅助通气(有创通气+无创通气)时间、抗生素使用时间(铜绿假单胞菌培养阳性前抗生素使用时间)及是否应用碳青霉烯类抗生素],分析两组患者临床特征差异、肺部铜绿假单胞菌感染的危险因素及耐药性。结果感染组患者FEV1%预计值≤30%、Pa O_2≤50 mmHg、PaCO_2≥80mm Hg、APACHEⅡ评分≥15分及合并肺源性心脏病的比例均显著高于非感染组(P<0.05)。感染组中行气管插管、辅助通气时间≥14天及抗生素使用时间≥14天的患者比例均显著高于非感染组(P<0.05),两组患者Bi PAP通气和应用碳青霉烯类抗生素患者比例比较均无显著差异(P>0.05)。多因素Logistic回归分析显示,合并肺源性心脏病、气管插管及辅助通气时间≥14天是COPD合并呼吸衰竭患者发生肺部铜绿假单胞菌感染的危险因素(P<0.05)。铜绿假单胞菌整体耐药性较高,仅对亚胺培南和头孢他啶的耐药率低于30%。结论 COPD合并呼吸衰竭患者肺部铜绿假单胞菌感染率较高,合并肺源性心脏病、气管插管及辅助通气时间≥14�Objective To investigate the risk factors of Pseudomonas aeruginosa in patients with chronic obstructive pulmonary disease(COPD)combined with respiratory failure.Method From January2015to December2016,198cases of COPD combined with respiratory failure treated in our hospital were selected as research objects.According to whether the patients developed pulmonary Pseudomonas aeruginosa infection or not,all patients were assigned into infection group(n=37)and non-infection group(n=161).The main clinical features were collected during hospitalization,including the severity[the percentage of forced expiratory volume in first second(FEV1)to predicted value(FEV1%pred),partial pressure of oxygen(PaO2),partial pressureof carbon dioxide(PaCO2),acute physiology and chronic health evaluationⅡ(APACHEⅡ)score and whether complicated with pulmonary heart disease]and clinical intervention[whether used tracheal intubation,whether used bilevel positive airway pressure(BiPAP)ventilation,ventilation(invasive ventilation+noninvasive ventilation)time,time of antibiotic use(utility time of antibiotic before Pseudomonas aeruginosa cultures were positive)and whether used carbapenem antibiotics].Clinical characteristics,pulmonary Pseudomonas aeruginosa infection risk factors and drug resistance of the two groups were analyzed.Result The proportions of FEV1%pred≤30%,PaO2≤50mmHg,APACHEⅡ≥15points,combined with pulmonary heart disease in infection group were significantly higher than those in non-infection group(P<0.05).The proportions of using tracheal intubation,ventilation time≥14days and time of antibiotic use≥14days in infection group were significantly higher than those in non-infection group(P<0.05).There were no significant differences in using BiPAP ventilation and using carbapenem antibiotics between the two groups(P>0.05).Multivariate Logistic regression analysis revealed that combined with pulmonary heart disease,used tracheal intubation and ventilation time≥14days were risk factors of Pseudomonas aeruginosa infec

关 键 词：呼吸衰竭 慢性阻塞性肺疾病 铜绿假单胞菌 危险因素 

分 类 号：R563.8[医药卫生—呼吸系统] R563.9[医药卫生—内科学]