摘要
目的了解老年人医院内获得性肺炎（HAP）的发病率，筛查并确定老年人HAP发病危险因素尤其是高危因素。方法多中心前瞻性队列研究。选2004年3—6月上海市31所二、三级医院新入院的老年患者为研究对象，统计HAP发病率及分析相关危险因素。结果（1）共入组5299例老年患者，年龄65～96（74．3±5．9）岁。合并慢性疾病的老年患者占28．5％。APACHEⅡ评分为5～31（8．3±3．4）分。确诊为HAP者255例（4．81％），发病率46．75／1000住院日，粗病死率为14．90％。（2）HAP发病率较高的科室依次为ICU（21．43％）、血液科（12．17％）、胸外科（11．41％）、呼吸科（7．92％）。（3）多因素logistic回归分析显示，入住二级医院或ICU、慢性阻塞性肺疾病病程≥10年、心肺功能不全、肝硬化失代偿期、卒中或脑外伤、免疫抑制、入院后使用抗菌药物或制酸剂、鼻胃管留置、机械通气、意识障碍、活动受限、血清白蛋白〈35g／L为老年人HAP发病的独立危险因素。结论老年人HAP发病的独立危险因素众多，需要综合防治才能有效控制HAP的发生。
Objective To investigate the incidence and the risk factors for hospital-acquired pneumonia （HAP） in the elderly in Shanghai. Methods This was a muhicenter prospective clinical cohort study. A total of 5299 patients more than 65 years old, admitted into 31 secondary or tertiary hospitals in Shanghai, were enrolled. Measurements of the demographic and potential risk factors reflecting illness severity, nutrition, drug exposure, surgery and ventilation were performed. Pneumonia was classified by the definition of Chinese Medical Association. Risk factors were analyzed by univariate Pearson Chi-squared test and muhivariable logistic regression analysis with backward （Likelihood ratio）. Results Of the enrolled patients, 2805 male and 2494 female, 255 （4. 81% ） developed hospital-acquired pneumonia. The incidence was 46.75/1000 hospitalizations. Among them 38 died; and the rough mortality was 14.90%. The incidence of HAP was higher in ICU （21.43%）, hematology （ 12. 17% ） , chest surgery （ 11.41% ） , and respiratory medicine （7.92%） departments. The mean of acute physiology and chronic health evaluation （APACHE Ⅱ ） score was 8.3 ± 3.4 （5-31）. Muhivariable logistic regression analysis with backward （Wald） method found that admission into secondary hospitals, admission into ICU, history of chronic obstructive pulmonary disease ≥ 10 years, immunosuppression, administration of antibiotics, insertion of nasogastric tube, mechanical ventilation, administration of H-2 antagonists or antacid and ≤ 7 d, central nervous system diseases, depressed level of consciousness, supine position, albumin 〈 35g/L were independent risk factors of HAP in the elderly. Conclusion Hospital-acquired pneumonia in the elderly was the usual type of nosocomial infections. The risk factors identified from this study may prove useful to target future clinical interventions to prevent HAP in the elderly.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2008年第1期31-35,共5页
Chinese Journal of Internal Medicine
基金
国家科技攻关计划：老年人下呼吸道感染综合干预的研究科研基金资助（2001BA702806）
