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目的分析神经内科老年患者医院获得性肺炎(HAP)的临床特点及相关危险因素,探讨其预防措施。方法 260例老年住院患者的临床资料。记录患者的年龄、性别、住院天数、合并心肺疾病、脑血管疾病史、吸烟史,抽取静脉血检查血清白蛋白、肌酐和血红蛋白等。所有患者均进行痰涂片和痰培养,连续2次培养为同一病原菌者确定为感染病原菌,未昏迷的患者自行咳痰,昏迷的患者需利用无菌吸痰管吸取痰液。结果本研究260例患者中感染医院获得性肺炎的患者有68例,感染率为26.15%,HAP组和无HAP组患者的年龄、性别、糖尿病情况差异无统计学意义(P>0.05);两组患者的血清白蛋白水平、血肌酐水平、血红蛋白水平、昏迷率、辅助呼吸率、心力衰竭比例等比较,差异具有统计学意义(P<0.05);68例合并医院获得性肺炎患者中,54例患者痰培养为阳性,阳性率为79.42%,共分离出10种致病菌,位于前5位的致病菌依次是铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌、鲍曼不动杆菌、金黄色葡萄球菌;老年HAP患者具有显著的不典型特点,精神萎靡或谵妄者所占比例为80.88%,咳嗽、咳痰者所占比例为27.94%,HAP组患者死亡32例,死亡率为47.06%,无HAP组患者死亡40例,死亡率为20.83%,两组数据比较,差异具有统计学意义(P<0.05)。结论神经内科老年患者获得性肺炎的临床表现不典型,死亡率较高,血清白蛋白水平、辅助呼吸以及每天半卧位时间时影响医院获得性肺炎的独立因素。
Objective To analyze the clinical characteristics and related risk factors of hospital acquired pneumonia (HAP) in the elderly patients of neurology department and explore the preventive measures. Methods 260 cases of elderly hospitalized patients clinical data. Record the patient’s age, gender, length of stay, cardiopulmonary disease, history of cerebrovascular disease, smoking history, venous blood samples for serum albumin, creatinine and hemoglobin. All patients were sputum smear and sputum culture, two consecutive times for the same pathogen identified as pathogenic bacteria, unconscious patients with their own sputum, coma patients need to use a sterile suction tube to absorb sputum. Results There were 68 cases of hospital acquired pneumonia in 260 patients, the infection rate was 26.15%. There was no significant difference in age, sex and diabetes between HAP group and non-HAP group (P> 0.05) The serum albumin level, serum creatinine level, hemoglobin level, coma rate, assisted breathing rate and the proportion of heart failure in the patients were significantly different (P <0.05). Among the 68 patients with hospital-acquired pneumonia, 54 The sputum culture of patients was positive, the positive rate was 79.42%, a total of 10 kinds of pathogenic bacteria were isolated. The top five pathogens were Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Acinetobacter, Staphylococcus aureus; aged HAP patients with significant atypical features, apathetic or delirium of the proportion of 80.88%, cough, sputum accounted for 27.94%, HAP group of patients died in 32 cases , And the mortality rate was 47.06%. There were 40 deaths and 20.83% deaths in the patients without HAP group. The difference between the two groups was statistically significant (P <0.05). CONCLUSIONS: The clinical manifestations of acquired pneumonia in elderly patients with neurological diseases are not typical, with high mortality, serum albumin levels, assisted breathing, and independent factors that affect hospital-acquired pneumonia at half-time per day.