摘要
背景精神障碍患者医院获得性肺炎(HAP)发病率高,是其主要死因之一。目前,国内外关于精神障碍患者HAP的发病率及危险因素的研究不多。目的探讨精神障碍患者HAP的发生情况及其影响因素,为临床治疗和医院感染防控提供依据。方法采用巢式病例对照研究方法,选取2018年1月至2019年12月在武汉大学人民医院精神卫生中心住院的9336例精神障碍患者进入研究队列,将住院期间发生HAP的精神障碍患者作为病例组,按照1∶3(或更小的比例)匹配在同时段住院、同病区、同年龄段、同观察时长、未发生HAP的精神障碍患者作为对照组,采集患者相关信息,包括性别、年龄、住院时间、血常规、合并疾病情况、抗精神病药物使用情况、合并流涎/吞咽障碍情况(患者出现明显的吞咽困难症状或有误吸病史被确定为吞咽障碍)等。采用多因素Logistic回归分析探讨精神障碍患者发生HAP的影响因素。结果9336例精神障碍患者中发生HAP有124例(病例组),发生率为1.33%;按照1∶3(或更小的比例)比例匹配,共入组334例未发生HAP的精神障碍患者(对照组)。病例组中住院时间长、住院期间使用氯氮平、使用非典型抗精神病药物、抗精神病药物≥2种、近半年发生过肺炎、有基础疾病、流涎/吞咽障碍、高血糖、精神分裂症所占比例均高于对照组(P<0.05)。多因素Logistic回归分析,结果显示,住院时间〔OR=1.025,95%CI(1.004,1.047)〕、住院期间使用氯氮平〔OR=3.634,95%CI(1.842,7.171)〕、抗精神病药物≥2种〔OR=2.653,95%CI(1.380,5.100)〕、有基础疾病〔OR=2.268,95%CI(1.167,4.411)〕、有流涎/吞咽障碍〔OR=56.726,95%CI(7.534,427.078)〕、高血糖〔OR=4.129,95%CI(1.032,16.520)〕是精神障碍患者发生HAP的危险因素(P<0.05)。结论为降低精神障碍患者HAP的发生率,在选择使用氯氮平时尤其注意HAP的监测和防控,对于有流涎/吞咽障碍、抗精神病药物联用、高血糖、基础疾病及因疾病情况需住院时间长等精神障碍患者需要加强HAP的监测。
Background Hospital-acquired pneumonia(HAP)is a high-incidence illness and a major leading cause of death in patients with mental disorders.However,there are few studies on the incidence and risk factors of HAP in these patients.Objective To explore the incidence and risk factors of HAP in patients with mental disorders,so as to provide a basis for clinical treatment and nosocomial infection prevention and control of this illness.Methods A nested case-control design was used.Mental disorder patients(n=9336)who were hospitalized in Mental Health Center,Renmin Hospital of Wuhan University from January 2018 to December 2019 were included in the study cohort,among whom those with HAP were assigned to the case group,and compared to those without HAP(control group)after being matched in a ratio of 1∶3 or less value of ratio based on hospitalization period,ward,age,and duration of observation.The clinical information of all patients was collected,including gender,age,length of stay,routine blood test parameters,combined diseases,use of antipsychotics,combined salivation/swallowing disorder(defined as having obvious dysphagia symptoms or a history of aspiration).Multivariate Logistic regression analysis was used to explore the risk factors of HAP in patients with mental disorders.Results Of the participants,124(1.33%)had HAP,and they were compared to 334 controls after matching.The case group had longer mean length of stay,higher prevalence of in-hospital use of clozapine,atypical antipsychotics,and antipsychotics≥2 types,pneumonia in the past two years,underlying diseases,salivation/dysphagia,hyperglycemia as well as schizophrenia(P<0.05).Multivariate Logistic regression analysis demonstrated that the longer length of stay〔OR=1.025,95%CI(1.004,1.047)〕,in-hospital use of clozapine〔OR=3.634,95%CI(1.842,7.171)〕,in-hospital use of two or more types of antipsychotics〔OR=2.653,95%CI(1.380,5.100)〕,prevalence of underlying diseases〔OR=2.268,95%CI(1.167,4.411)〕,prevalence of salivation/swallowing disorder〔OR=56.726,95%CI(7.534,427.078)〕,and prevalence of hyperglycemia〔OR=4.129,95%CI(1.032,16.520)〕were risk factors of HAP in patients with mental disorders(P<0.05).Conclusion To reduce the incidence of HAP in patients with mental disorders,special attention should be paid to the monitoring,prevention and control of HAP in those using clozapine.The monitoring of HAP should also be strengthened in those with salivation/swallowing disorders,combined use of antipsychotics,having hyperglycemia,underlying diseases and longer hospital stay due to disease conditions.
作者
韩静静
武宇
王高华
王坚苗
HAN Jingjing;WU Yu;WANG Gaohua;WANG Jianmiao(Department of Nosocomial Infection Prevention and Control,Renmin Hospital of Wuhan University(East Campus),Wuhan 430299,China;Department of Nosocomial Infection Prevention and Control,Renmin Hospital of Wuhan University,Wuhan 430060,China;Mental Health Center,Renmin Hospital of Wuhan University,Wuhan 430060,China;Department of Respiratory and Critical Care Medicine,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Infection Control,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)
出处
《中国全科医学》
CAS
北大核心
2021年第29期3729-3733,共5页
Chinese General Practice
关键词
精神障碍
医疗相关性肺炎
医院获得性肺炎
影响因素分析
巢式病例对照研究
Mental disorders
Healthcare-associated pneumonia
Hospital acquired pneumonia
Root cause analysis
Nested case control study
