老年痴呆医院肺部感染病原菌与影响因素  

Analysis of the distribution of pathogenic bacteria and influencing factors of nosocomial pulmonary infection in patients with Alzheimer′s disease

作　　者：李萍[1] 冯俊艳[1] 麻霞[1] 许亚萍 杨帆[2] LI Ping;FENG Jun-yan;MA Xia;XU Ya-ping;YANG Fan(Second Hospital of Hebei Medical Universily,Shijiazhuang,Hebei 050000,China)

机构地区：[1]河北医科大学第二医院神经内科,河北石家庄050000 [2]河北省胸科医院呼吸内科,河北石家庄050000

出　　处：《中华医院感染学杂志》2020年第22期3424-3428,共5页Chinese Journal of Nosocomiology

基　　金：河北省医学科学研究重点计划基金资助项目(20130483)。

摘　　要：目的探讨老年痴呆患者发生医院肺部感染的高危影响因素,为临床防控治疗工作提供理论指导。方法选取河北医科大学第二医院在2016年1月-2019年3月间收治的140例老年痴呆患者作为研究对象,收集患者的临床资料并对患者进行呼吸道感染培养试验,分析比对其中73例阿尔茨海默病(AD)患者与67例血管性痴呆(VD)患者肺部感染的病原菌分布状况以及主要影响因素。结果 140例老年痴呆患者中,有52例患者存在肺部感染;73例AD患者中有27例患者出现肺部感染,感染率为36.99%;67例VD患者中有25例患者出现肺部感染,感染率为37.31%,两组比较差异无统计学意义。52例患者痰标本共分离出101株病原菌,两组患者主要感染的病原体类型为铜绿假单胞菌、肺炎链球菌、大肠埃希菌和流感病毒等。多因素分析结果显示,糖尿病、吸烟史、抗菌药物使用、癌症或肿瘤是AD患者出现肺部感染的独立危险因素(P<0.05);合并高血脂、长期卧床和抗菌药物使用是VD患者出现肺部感染的独立危险因素(P<0.05)。结论老年痴呆患者群体具有较高的医院内肺部感染率,且AD患者与VD患者的独立危险因素间存在一定差异,不同类型的老年痴呆患者其肺部感染影响因素不同,因此在老年痴呆肺部感染患者的临床治疗中需要予以其更多的关注和监护。OBJECTIVE To explore the high-risk influencing factors of nosocomial pulmonary infection in patients with dementia and provide theoretical guidance for the clinical prevention and treatment of the disease. METHODS A total of 140 patients with Alzheimer′s disease who were admitted to the second hospital of Hebei Medical University from Jan. 2016 to Mar. 2019 were enrolled. The patient′s clinical data were collected and the respiratory infection culture detection was performed on the patients. The distribution of pathogens and the risk factors of the infection in 73 patients with Alzheimer′s disease(AD) and 67 patients with vascular dementia(VD) were analyzed. RESULTS Of the 140 patients with Alzheimer′s disease, 52 were found to have lung infections. Pulmonary infection occurred in 27 of 73 patients with AD, with the infection rate of 36.99%, and pulmonary infection occurred in 25 of 67 patients with VD, with the infection rate of 37.31%;and the difference between the two groups was not significant. According to the results of the sputum culture test, a total of 101 pathogenic bacteria were isolated from 52 patients. The main pathogens in the two groups were Pseudomonas aeruginosa, Streptococcus pneumoniae, Escherichia coli, and influenza virus. Multivariate analysis showed that diabetes, smoking history, antibacterial drug abuse, cancer or tumor were independent risk factors for lung infection in AD patients(P<0.05);complication with hyperlipidemia, long-term bed rest and antibacterial drug abuse were independent risk factors of pulmonary infection in patients with VD(P<0.05). CONCLUSION Patients with Alzheimer′s had high infection efficiency, and there were some differences of independent risk factors between AD patients and VD patients. Different types of Alzheimer′s patients have different influencing factors of pulmonary infection. Therefore, more attention and supervision should be paid to the patients in the clinical treatment of Alzheimer′s pulmonary infection.

关 键 词：阿尔茨海默病 血管性痴呆 肺部感染 病原菌分布 铜绿假单胞菌 肺炎链球菌 危险因素 

分 类 号：R749.1[医药卫生—神经病学与精神病学]