老年冠心病血运重建术后呼吸道病原微生物感染影响因素及药物经济学评价浅析  

Analysis of influencing factors and pharmacoeconomic evaluation of respiratory pathogenic microbial infection after revascularization in elderly patients with coronary heart disease

作　　者：邵显姝 刘波[2] 王岚岚 邹明月 叶志青[3] 于洋[1] SHAO Xianshu;LIU Bo;WANG Lanlan;ZOU Mingyue;YE Zhiqing;YU Yang(Western Pharmacy Department,Wuhan Sirth Hospital,Wuhan 430015,China;Department of Vascular Medicine,Wuhan Sirth Hospital;Pharmacy Department,Wuhan Sirth Hospital)

机构地区：[1]武汉市第六医院西药剂科,湖北武汉430015 [2]武汉市第六医院心血管内科 [3]武汉市第六医院药剂科

出　　处：《中国病原生物学杂志》2025年第3期365-369,共5页Journal of Pathogen Biology

基　　金：湖北省卫健委科研项目(No.WJ2021M029)。

摘　　要：目的探究老年冠心病血运重建术后呼吸道病原微生物感染的相关影响因素,同时开展药物经济学评价,综合考量感染患者和未感染患者成本、效果、效益及效用。方法选取2023年1月-2024年6月在本院接受老年冠心病血运重建术的患者120例作为研究对象。收集所有患者临床资料;经纤维支气管镜采集患者支气管肺泡灌洗液并行呼吸道病原菌微生物检验;采用成本-效果分析(CEA)和成本-效用分析(CUA)相结合的方法进行药物经济学评价。单因素分析感染组和未感染组临床特征差异;Logistic多因素回归分析老年冠心病血运重建术后呼吸道病原微生物感染影响因素;术后呼吸道病原微生物感染病原微生物的种类分布情况;对比感染组和未感染组CEA和CUA情况。结果根据呼吸道病原菌微生物检验,分为感染组(n=40)、未感染组(n=80);感染组合并糖尿病、合并慢性阻塞性肺疾病、术中出血量>200 mL、机械通气时间>12 h和住重症监护病房时间>2 d占比均显著高于未感染组(均P<0.05);Logistic回归结果显示合并糖尿病、合并慢性阻塞性肺疾病、术中出血量>200 mL、机械通气时间>12 h和住重症监护病房时间>2 d是老年冠心病血运重建术后呼吸道病原微生物感染发生的独立危险因素(P<0.05);40例感染样本中病原菌共分离出117株,革兰阴性菌前三为铜绿假单胞菌(19.66%)、鲍曼不动杆菌(11.97%)和肺炎克雷伯菌(11.11%);革兰阳性菌前三为金黄色葡萄球菌(9.40%)、表皮葡萄球菌(5.13%)与肺炎链球菌(2.56%);真菌中包括白假丝酵母菌(11.97%)和热带假丝酵母菌(5.13%);感染组总治疗成本和CEA明显高于未感染组,总治愈率明显低于未感染组(均P<0.05);CUA为41971元/QALYs。结论合并糖尿病、合并慢性阻塞性肺疾病、术中出血量>200 mL、机械通气时间>12 h和住重症监护病房时间是老年冠心病血运重建术后呼吸道病原微生物感染独立Objectivee To explore the related influencing factors of respiratory pathogenic microbial infection after coronary heart disease revascularization in elderly patients,and carry out pharmacoeconomic evaluation to comprehensively consider the cost,effect,benefit and utility of infected patients and uninfected patients.Methods A total of 12o patients who were received revascularization in elderly patients with coronary heart disease in our hospital from January 2023 to June 2024 were selected as the study objects.Clinical data of all patients were collected;Bronchoalveolar lavage fluid was collected by bronchoscope and microbial examination of respiratory pathogens was performed.A combination of costeffectiveness analysis(CEA)and cost-effectiveness analysis(CUA)was used for pharmacoeconomic evaluation.The difference of clinical features between infected group and uninfected group was analyzed by single factor.The influencing factors of respiratory pathogenic microorganism infection after coronary heart disease revascularization were analyzed by Logistic regression.The species distribution of postoperative respiratory pathogenic microorganisms was analyzed.CEA and CUA were compared between infected and uninfected groups.Results According to the microbiological test of respiratory pathogens,the group was divided into infected group(n=40)and uninfected group(n=80);The percentage of infected group combined with diabetes mellitus,combined with chronic obstructive pulmonary disease,intraoperative bleeding>200 mL,mechanical ventilation time>12 h and stay in the intensive care unit for>2 d were significantly higher than that of the uninfected group(all P<0.05);The results of Logistic regression showed that combined Diabetes mellitus,chronic obstructive pulmonary disease,intraoperative bleeding>200 mL,mechanical ventilation time>12 h and intensive care unit stay>2 d were independent risk factors for the occurrence of respiratory pathogenic microbial infections after coronary artery disease haemodialysis in the elderly(P<0.05

关 键 词：冠心病血运重建术 呼吸道病原微生物感染 影响因素 药物经济学 

分 类 号：R54[医药卫生—心血管疾病]