危重症心力衰竭患者肺部感染的病原菌分布及其影响因素研究

［摘要］目的分析危重症心力衰竭患者肺部感染病原菌分布情况以及有关的影响因素。方法选取危重症心力衰竭患者80例作为研究对象，根据其是否发生肺部感染分为感染组39例与未感染组41例，比较2组患者临床基线资料，采用单因素与多因素Logistic回归分析导致其发生肺部感染的影响因素与，并收集感染组患者痰液样本对感染病原菌分布进行分析记录。结果单因素分析显示：年龄较大、有吸烟、有糖尿病史、有高血压、有慢性阻塞性肺疾病史、有抗生素或激素滥用、左心室射血分数（left ventricular ejection fractions,LVEF）<35%、LVEF 35%~54%、住院时间较长、C反应蛋白（C-reactive protein,CRP）表达较高属于导致患者感染的影响因素，差异有统计学意义（P＜0.05或P＜0.01）。多因素Logistic回归分析显示：有吸烟、有糖尿病史、有慢性阻塞性肺疾病史、有抗生素或激素滥用、LVEF<35%、CRP表达较高属于导致患者感染的危险因素，差异有统计学意义（P＜0.05）。39例患者共检出病原菌42株，其中革兰阴性菌28株（66.67%）；革兰阳性菌11株（26.19%）；真菌3株（7.14%）。结论危重症心力衰竭发生肺部感染患者其病原菌主要以革兰阴性菌为主，其次为革兰阳性菌，真菌占比相对较少，有吸烟、有糖尿病史、有慢性阻塞性肺疾病史、有抗生素或激素滥用、LVEF<35%、CRP表达较高属于导致肺部感染的危险因素，临床中对于存在上述因素的患者需格外注意。

Study on the distribution of pathogenic bacteria and its influencing factors in patients with critical heart failure with pulmonary infection

［Abstract］ ObjectiveTo analyze the distribution of pathogenic bacteria in pulmonary infection and related influencing factors in patients with critical heart failure. 〖WTHZ〗MethodsEighty patients with critical heart failure treated were divided into infection group(n=39) and uninfected group(n=41) according to whether or not pulmonary infection occurred. The clinical baseline data of the two groups were compared, and the influencing factors and independent risk factors of pulmonary infection were analyzed by univariate and multivariate Logistic regression analysis. The sputum samples of the infected group were collected and the distribution of pathogenic bacteria was analyzed and recorded. 〖WTHZ〗ResultsSingle factor analysis showed that age, smoking, diabetes, hypertension, chronic obstructive pulmonary disease, antibiotic or hormone abuse, left ventricular ejection fraction(left ventricular ejection fractions,LVEF)<35%, LVEF 35%-54%, longer hospital stay and higher expression of C-reactive protein（CRP） were the influencing factors of infection in patients, and the difference was statistically significant(P＜0.05 or P＜0.01). Multivariate logistic regression analysis showed smoking, diabetes, chronic obstructive pulmonary disease and antibioticsor hormone abuse, LVEF<35%, and higher expression of CRP were among the independent risk factors leading to infection in patients, with a statistically significant difference(P＜0.05). A total of 42 pathogens were detected in 39 patients, including 28 Gram-negative bacteria(66.67%),11 Gram-positive bacteria(26.19%) and 3 fungal strains(7.14%). 〖WTHZ〗ConclusionThe main pathogens of pulmonary infection in patients with critical heart failure are gram-negative bacteria, followed by gram-positive bacteria, with relatively few fungi, smoking, history of diabetes, history of chronic obstructive pulmonary disease, abuse of antibiotics or hormones, LVEF<35%, and high expression of CRP are independent risk factors leading to infection.