老年医院获得性肺炎病原学及预后危险因素分析

目的 了解并探讨老年医院获得性肺炎(HAP)的临床特点、病原学分布、影响预后因素等.方法 回顾性分析2002年1月-2011年12月老年病房中669例,年龄≥65岁老年HAP患者的临床资料；通过单因素与多因素分析方法研究影响老年HAP的多种预后因素.结果 总共培养出的1130株病原菌,其中革兰阴性菌1000株,占88.5％,革兰阳性菌130株,占11.5％,居前3位的病原菌为铜绿假单胞菌、鲍氏不动杆菌及嗜麦芽寡养单胞菌,占61.9％、9.4％及6.1％；机械通气、受累肺叶数、胸腔积液情况及APACHEⅡ评分是影响老年患者HAP预后的因素.结论 老年医院获得性肺炎病原菌分布广、患者病情重、机械通气比例较高,加之需要多种侵入性操作和治疗导致其死亡率较高.

Etiology of hospital-acquired pneumonia in elderly patients and risk factors for prognosis

OBJECTIVE To investigate the clinical characteristics,etiologic distribution,and impact factors for prognosis of the hospital-acquired pneumonia(HAP) in the senile patients.METHODS A cohort of 669 elderly patients from geriatric wards which were diagnosed as HAP from Jan 2002 to Dec 2011 were retrospectively studied.All the enrolled patients were with the age above 65 years.By means of the univariate analysis and multivariate logistic regression analysis,the multiple factors for the prognosis of the elderly patients with HAP were observed.RESULTS A total of 1130 strains of pathogens were isolated,including 1000(88.5%) strains of gram-negative bacteria and 130(11.5%) strains of gram-negative bacteria.The top three species of pathogens were Pseudomonas aeruginosa(61.9%),Acinetobacter baumannii(9.4%),and Stenotrophomonas maltophilia(6.1%).The mechanical ventilation,number of affected lung lobes,pleural effusion and APACHEⅡ score are the impact factors for the prognosis of the patients with HAP.CONCLUSION The pathogens causing HAP in the elderly patients distribute widely,the condition is severe,with high proportion of mechanical ventilation,the mortality is high due to the multiple invasive operation and treatment.