老年尘肺患者医院感染相关危险因素分析及干预研究  

Risk factors analysis of nosocomial infection in elderly patients with pneumoconiosis

作　　者：刘璠 喻威 任斯诗 LIU Fan;YU Wei;REN Si-shi(Wuhan Union Red Cross Hospital,Wuhan 430000,China)

机构地区：[1]协和武汉红十字会医院,湖北武汉430000

出　　处：《工业卫生与职业病》2020年第6期474-477,共4页Industrial Health and Occupational Diseases

摘　　要：目的研究老年尘肺患者的医院感染特征、危险因素及有效干预措施,为保护工人健康提供科学依据。方法 2013年1月-2019年12月,收治某医院271例老年尘肺患者(尘肺组)统计其医院感染发生情况、感染部位及病原菌分布,并与200名年龄、性别匹配的呼吸内科住院老年患者(对照组)进行比较。采用单因素分析及logistic多因素回归分析相关危险因素。结果尘肺组医院感染率为19.93%,高于对照组的11.50%,差异有统计学意义(P<0.05)。尘肺组54例发生医院感染患者共检出病原菌57株,其中革兰阴性菌占73.68%,革兰阳性菌占22.81%,真菌占3.51%;对照组23例医院感染患者共检出病原菌27株,革兰阴性菌占比70.37%,革兰阳性菌占比18.52%,真菌占比11.11%。两组的病原菌种类大体结构相似,尘肺组铜绿假单胞菌相对多见,对照组鲍曼不动杆菌、阴沟肠杆菌及真菌检出率相对更高。单因素及logistic多因素分析显示,尘肺分期、肺损伤程度、合并肺结核、不合理使用抗生素、侵入性操作、低白蛋白、住院时间是独立危险因素,肺泡灌洗是保护性因素(P<0.05)。结论老年尘肺患者有较高的医院感染发生风险,尘肺晚期、肺损伤严重、合并肺结核、抗生素使用不合理、低白蛋白、侵入性操作及住院时间较长患者有更高的医院感染风险。Objective To study the characteristics,risk factors and effective intervention measures of nosocomial infection in elderly pneumoconiosis patients,so as to provide scientific basis for protecting workers’health.Methods From January 2013 to December 2019,271 elderly pneumoconiosis patients admitted to a hospital were selected as pneumoconiosis group and 200 elderly patients in the department of Respiratory Medicine in the same hospital as control group,after being matched by age and sex.The occurrence,infection site and pathogen distribution of their nosocomial infectionwere compared between the two groups.Univariate analysis and logistic multivariate regression were used to analyze the risk factors.Results The nosocomial infection rate in the pneumoconiosis group was 19.93%,higher than that in the control group(11.50%),and the difference was statistically significant(P<0.05).57 strains of pathogenic bacteria were detected in 54 patients with nosocomial infection in the pneumoconiosis group,among which gram negative bacteria accounted for 73.68%,gram positive bacteria accounted for 22.81%and fungus accounted for 3.51%.A total of 27 strains of pathogenic bacteria were detected in 23 patients with nosocomial infection in the control group,with gram-negative bacteria accounting for 70.37%,gram-positive bacteria 18.52%and fungi 11.11%.The pathogen species of the two groups were similar in general structure.Pseudomonas aeruginosa was relatively common in the pneumoconiosis group,while the detection rate of acinetobacter baumannii,Enterobacter cloacae and fungi were relatively higher in the control group.Univariate and logistic multivariate analysis showed that pneumoconiosis stage,degree of lung injury,pulmonary tuberculosis,unreasonable use of antibiotics,invasive procedures,low albumin,and length of hospital stay were independent risk factors,while alveolar lavage was protective(P<0.05).Conclusions Elderly pneumoconiosis patients had a higher risk of nosocomial infection,advanced pneumoconiosis,severe lung injury,a

关 键 词：尘肺 老年 医院感染 危险因素 

分 类 号：R135.2[医药卫生—劳动卫生]