老年COPD患者肺部感染的影响因素及临床药师的干预作用研究  

Influencing Factors of Pulmonary Infections in Elderly Patients with COPD and Intervention Effect of Clinical Pharmacists

作　　者：马燕 喻存俊[2] 童维佳[1] 朱文玉[1] MA Yan;YU Cunjun;TONG Weijia;ZHU Wenyu(Department of Pharmacy,Nanjing Chest Hospital,Nanjing 210029,China)

机构地区：[1]南京市胸科医院药学部,南京210029 [2]南京市胸科医院呼吸科

出　　处：《解放军预防医学杂志》2019年第1期8-11,共4页Journal of Preventive Medicine of Chinese People's Liberation Army

基　　金：南京市医学科技发展项目(No.ZKX16065)

摘　　要：目的探究影响老年COPD患者肺部感染的危险因素及临床药师的干预作用。方法选取2016年1月-2018年1月在南京市胸科医院接受救治的181例COPD患者纳入本次研究。根据是否发生肺部感染,分为感染组和非感染组。采用单因素及多因素Logistic回归分析影响COPD老年患者肺部感染的危险因素。比较COPD老年肺部感染患者治疗前后炎性指标水平、感染控制情况及不良反应发生率。结果 181例COPD老年患者中83例(45.86%)患者发生肺部感染。单因素及多因素Logistic回归分析结果显示年龄、呼吸情况、抗菌药物滥用情况、合并症及住院时间是影响COPD老年患者肺部感染的危险因素。监护组和对照组患者治疗后,WBC、PCT和hs-CRP水平均较治疗前降低,差异均有统计学意义(P均<0.05)。监护组患者治疗后,WBC、PCT和hs-CRP水平降低较对照组更为明显,差异有统计学意义(P<0.05)。监护组患者肺部感染治疗的总有效率高于对照组,不良反应发生率低于对照组,差异均有统计学意义(P均<0.05)。结论高龄、机械通气、滥用抗菌药物、合并症>2种及住院时间长是COPD老年患者肺部感染的独立危险因素。临床药师干预COPD老年肺部感染患者治疗有利于提高治疗效果。Objective To explore both the risk factors for pulmonary infections in elderly patients with COPD and the intervention effect of clinical pharmacists.Methods One hundred and eighty-one cases of patients with COPD treated in Nanjing Chest Hospital between January 2016 and January 2018 were selected as the subjects,who were divided into the infected group and the non-infected group according to the occurrence of pulmonary infections.Univariate and multivariate logistic regression was used to analyze risk factors for pulmonary infections in elderly patients with COPD.Levels of inflammatory markers,infection control and adverse reactions before and after treatment were compared between these patients.Results Among the 181 elderly patients with COPD,83(45.86%)had pulmonary infections.Univariate and multivariate logistic regression analysis showed that age,respiratory status,antimicrobial abuse,comorbidities,and length of hospital stay were risk factors for pulmonary infections in elderly patients with COPD.After treatment,the levels of WBC,PCT and hs-CRP were lower,and the difference was statistically significant(P<0.05).After treatment,the levels of WBC,PCT and hs-CRP in the monitoring group were significantly lower than those in the control group,and the difference was statistically significant(P<0.05).The total effective rate of pulmonary infection cure in the monitoring group was higher than that in the control group,while the rate of adverse reactions was lower,and the difference was statistically significant(P<0.05).Conclusion Old age,mechanical ventilation,abuse of antibiotics,comorbidities>2 and long hospital stay are independent risk factors for pulmonary infections in elderly patients with COPD.The intervention by clinical pharmacists in the treatment of pulmonary infections among elderly patients with COPD can help improve the therapeutic effect.

关 键 词：慢性阻塞性肺疾病 肺部感染 老年 危险因素 临床药师 

分 类 号：R563.1[医药卫生—呼吸系统]