医院感染危险因素分析及护理措施探讨

目的：分析引起医院感染的危险因素，探讨预防性护理干预措施对降低医院感染发生率的价值。方法回顾性分析本院住院患者1160例临床资料，根据所接受的护理方式不同，分为医院感染预防性护理干预组（研究组）600例及传统护理组（对照组）560例，统计学方法分析医院感染危险因素，并比较两组患者医院感染发生情况。结果老年、住院时间超出7d、侵入性治疗、插管治疗和合并基础性疾病是医院感染的危险因素（P＜0．05）。经预防性护理干预的研究组患者医院感染总发生率明显低于对照组，各脏器系统的医院感染发生率也明显低于对照组，组间比较差异均有统计学意义（P＜0．05）。结论高龄、住院时间长、侵入性治疗、插管治疗以及合并基础性疾病均为医院感染的危险因素，积极地实施预防性护理干预对避免和减少医院感染的发生具有重要意义。     

脑卒中患者医院获得性肺炎的危险因素

目的分析脑卒中患者医院获得性肺炎（HAP）常见的危险因素。方法对512例住院脑卒中患者资料进行回顾性分析，脑卒中患者发生脑卒中的类型、有无意识障碍、吞咽功能以及常见基础疾病如糖尿病、基础肺疾病HAP的发生率进行比较，并进行统计学分析。结果脑卒中患者HAP发生率33．0％，脑出血组发生率明显高于脑梗死组，有意识障碍、吞咽功能障碍、糖尿病和基础肺疾病的患者发生率明显高于无上述症状及基础病的患者，差异具有统计学意义．结论脑卒中的类型、有无意识障碍和吞咽功能障碍及是否合并糖尿病、基础肺疾病是脑卒中患者发生HAP的危险因素。     

60岁以上老年人误吸发病率及危险因素分析

目的：分析60岁以上老年人的误吸发病率及其危险因素。方法选取2013年1月至2014年7月西安解放军323医院收治的住院老年患者250例（住院组）,另选取同期在莲湖区西大街社区居住的老年人250例（社区组）,回顾性分析老年人的误吸发病率及其危险因素,比较两组老年人的临床资料、不同量表的评分结果及近1年内的误吸发生情况,并对调查结果与误吸发生率的相关性进行分析。结果两组样本的性别比例和个人史比较,差异均有统计学意义（P＜0．05）;患者既往疾病史中,心脑血管疾病与消化系统疾病的发生率比较,差异无统计学意义（P＞0．05）。两组患者的年龄和各个量表的评分比较,差异具有统计学意义（P＜0．05）;住院组近1年的误吸发生率（24．40％）高于社区组（9．60％）,两组样本近1年的误吸发生情况比较,差异有统计学意义（ Z＝12．41, P＜0．05）;患者年龄、异常进餐、进餐体位改变、各种既往疾病和4种量表的评分结果与误吸的发生明显相关（P＜0．05）。结论住院老年人的误吸发生率较社区老年人高,发病因素较为复杂,临床上对老年住院患者进行护理时应充分考虑多种危险因素,避免误吸的发生。     

机械通气老年患者院内气管支气管炎危险因素分析

目的 探讨机械通气老年患者并发院内气管支气管炎（NTB）的危险因素，为制定院内感染防治措施提供流行病学资料和科学依据。方法 应用前瞻性队列研究方法，观察2002年10月-2004年7月收治上海复旦大学附属中山医院外科重症监护室（SICU）内的老年机械通气患者的临床资料，进行单因素和多因素Logistic回归分析。结果 符合标准的66例SICU内机械通气老年患者有35例发生NTB（发生率为53．03％）。NTB组和非NTB组在低白蛋白血症、鼻饲情况、机械通气时间、急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）、抗生紊使用种数以及住SICU时间方面差异均有显著性（P〈0．05或P〈0．01）。单因素分析显示：鼻饲、低白蛋白血症、机械通气时间〉4d、住SICU时间〉9d、抗生素使用种数增加以及APACHEⅡ评分〉9分是NTB发生的重要危险因素;Logistic多因素回归分析显示：鼻饲、机械通气时间〉4d、抗生素使用种数〉2种是NTB的独立发病危险因素。结论 SICU内机械通气老年患者NTB的发生率较高，是影响患者预后的重要因素之一。机械通气时间延长、ICU内住院时间延长、低白蛋白血症、高APACHEⅡ评分、大量使用抗生素等是NTB发生的重要危险因素。     

老年人无症状性脑梗死56例临床分析

目的：探讨老年非脑卒中患者无症状脑梗死的发生率、影像学特征及危险因素。方法：186例非脑卒中老年患者行颅脑CT检查发现无症状脑梗死56例，分析其影像学特征，并对危险因素与非无症状脑梗死患者进行对比分析。结果；无症状脑梗死发生率为30．11％，男高于女；颅脑CT检查96．92％为腔隙性梗死，68．48％分布于基底节和内囊；无症状脑梗死组较症状脑梗死组年龄大，伴发高血压、糖尿病、高酯血症、心脏病及吸烟史高（P〈0．05）；血压值、血糖、血甘油三酯检测值及心电图异常率高（P〈0．05）。结论：无症状脑梗死在老年人群中常见，多为皮质下深部脑组织的腔隙灶，随着年龄的增长而增加，并与高血压痛、糖尿病、心脏病、高甘油三酯血症、吸烟史有关。     

老年恶性肿瘤患者并发医院获得性肺炎的临床分析

目的：探讨老年肿瘤患者并发医院获得性肺炎的危险因素。方法：选择南通市老年康复医院并发医院获得性肺炎的老年肿瘤患者50例为观察组,随机选择同时段住院治疗未并发医院获得性肺炎的老年肿瘤患者50例为对照组。从住院时间、肿瘤分期、功能状态评分（PS评分）、糖皮质激素的使用、应用广谱抗菌药物、侵入性操作、手术、放疗/化疗、贫血、中性粒细胞缺乏、血清白蛋白水平、是否合并糖尿病、慢性阻塞性肺病（COPD）、长期吸烟等方面比较两组的差异。结果：住院时间≥30d、肿瘤分期（Ⅲ＋Ⅳ期）、贫血、中性粒细胞缺乏、PS评分、血清白蛋白水平〈30g/L、COPD病史方面两组比较差异有统计学意义（P〈0.01）,糖皮质激素的使用、应用广谱抗菌药物、侵入性操作、手术、放疗/化疗、是否合并糖尿病、长期吸烟方面两组比较差异有统计学意义（P〈0.05）。结论：多种危险因素可以导致老年肿瘤患者并发医院获得性肺炎感染,应该采取积极有效的预防措施,并进行规范治疗。     

脑卒中后吞咽障碍患者发生相关性肺炎的危险因素分析

目的：探讨康复期的老年缺血性脑卒中后吞咽障碍患者发生脑卒中相关性肺炎（SAP）的危险因素.方法：脑卒中后吞咽障碍患者148例,回顾性分析患者年龄、性别、糖尿病和房颤病史、鼻胃管进食、构音障碍、肺炎、改良Barthel指数、脑卒中分类、外周血淋巴细胞计数,用多因素Logistic回归探讨发生SAP的相关影响因素.结果：148例中发生SAP感染56例（37.8％）,未发生SAP感染92例;通过多因素Logistic 回归调整年龄和性别等因素后发现,误吸、年龄≥75岁、男性、糖尿病、房颤是康复期老年脑卒中后吞咽障碍患者SAP的独立危险因素（P＜0.01,0.05）,外周血淋巴细胞计数高是其保护因素（P＜0.05）.此外鼻胃管进食、构音障碍也是该类患者SAP发生的影响因素（P＜0.01,0.05）.结论;老年脑卒中后吞咽障碍患者发生SAP的风险值得关注,通过对这一系列危险因素的筛查和监控,可提高医院和家庭对康复期老年脑卒中后吞咽障碍患者的重视程度,改善其预后.     

妇科手术患者医院感染危险因素研究

目的：探讨妇科手术患者发生医院感染的危险因素,为预防和减少妇科手术感染提供参考依据。方法共纳入妇科手术患者399人,记录患者的相关信息,并根据其是否发生医院感染分为感染组和对照组,采用非条件Logistic回归分析进行相关因素分析。结果399例手术患者中,10人发生医院感染,多因素Logistic回归分析结果显示：住院天数（OR＝1．123,P＜0．01）、手术持续时间（OR＝1．028,P＝0．009）、抗生素使用合理性（OR＝0．201,P＝0．044）均进入方程。结论住院天数、手术持续时间、抗生素使用合理性为患者发生医院感染的独立危险因素。     

住院与非住院老年人口咽部带菌情况比较

目的了解老年住院患者及非住院老年人口咽部细菌携带及其耐药情况、细菌携带的危险因素。方法住本院老年科非感染患者及进行健康体检的上海市离、退休干部为调查对象，以无菌生理盐水漱口后，采集咽拭子，进行细菌培养及鉴定。以纸片扩散法进行药敏测定。结果住院及非住院老年人口咽部的细菌携带率分别为55．2％（5S／105）及32．1％（161／501），老年住院患者高于非住院老年人（P〈0．01）；携带菌中均主要为嗜血杆菌属，其次为肺炎克雷伯菌等革兰阴性杆菌。老年住院患者携带的肺炎克雷伯菌对各类抗菌药的敏感率低于非住院老年人。口腔装有义牙是住院及非住院老年人口咽部带菌的危险因素。结论老年住院患者口咽部细菌携带率高于非住院老年人，口腔义牙是老年人口咽部带菌的危险因素。     

导管监控评分表预防老年住院患者意外拔管

目的探讨预防老年住院患者意外拔（脱）管的方法。方法选取我科2008年老年住院患者219例作为对照组,采用常规的安全教育与护理措施;2009年老年住院患者245例作为改进组,使用导管监控评分表进行导管种类与危险程度评估,并制定相应的安全防范措施。比较两组患者住院期间意外拔（脱）管事件的发生率。结果改进组患者在住院期间发生意外拔（脱）管事件的发生率为0．7％,对照组的为4．8％,两组比较差异有统计学意义（P〈0．01）。结论在老年住院患者中使用导管监控评分表,可明显降低意外拔（脱）管的发生率。     

青年女性缺血性卒中病因分型特点及相关危险因素分析

目的:探讨青年女性急性缺血性卒中患者的病因分型特点和相关危险因素。方法:回顾性分析急性缺血性卒中青年女性患者67例(青年女性卒中组)的临床资料,同时随机抽取老年女性卒中患者(老年女性卒中组)和同期健康体检的青年女性(青年女性对照组)各67例,分析卒中患者的病因分型特点及相关危险因素。结果:①依据中国缺血性卒中(CISS)分型,青年女性卒中组以大动脉粥样硬化(32.84%)和心源性卒中(25.37%)为主。②危险因素方面,青年女性卒中组高血压、糖尿病、高脂血症、动脉粥样硬化斑块阳性患者的比例明显低于老年女性卒中组(均P<0.05),但卒中家族史阳性患者比例高于老年女性卒中组(P<0.05);青年女性卒中组患者高血压、糖尿病、高脂血症、高同型半胱氨酸血症、吸烟、心脏病史、口服避孕药、先兆性偏头痛和卒中家族史阳性患者的比例明显高于青年女性对照组(均P<0.05)。③多因素Logistic回归分析结果显示高血压、糖尿病、高脂血症、高同型半胱氨酸血症和吸烟是青年女性卒中的独立危险因素。结论:青年女性缺血性卒中病因分型构成和相关危险因素与老年女性患者分布不同。早期明确病因分型和发现危险因素有利于青年女性缺血性卒中的防治。     

Practical prevention and treatment of cardiovascular diseases in patients with diabetes mellitus type 2 in an endocrinological department

AIM: To analyse retrospectively quality of medical correction of modified risk factors (RF) and treatment of cardiovascular diseases (CVD) in patients with diabetes mellitus type (DM) 2 admitted to specialized endocrinological departments. MATERIAL AND METHODS: Analysis of medication policy of CVD RF was made retrospectively for 250 patients treated in endocrinological departments of Moscow hospital in 2003. RESULTS: Arterial hypertension, coronary heart disease were diagnosed in 93.2 and 87.2% examinees. History of myocardial infarction and brain stroke was in 8.4 and 6% patients. Statins were prescribed in 2.4% cases. Examination for dyslipidemia was not satisfactory. ACE inhibitors were prescribed in 71.2% patients. Aspirin was prescribed (18%) primarily by the cardiologist. CONCLUSION: Quality of medical prophylaxis of CVD RF in DM type 2 patients in the departments does not satisfy modern clinical recommendations.     

≥75岁急诊心房颤动患者的预后分析——中国急诊心房颤动研究的亚组分析

目的:了解老年（年龄≥75岁）急诊心房颤动（房颤）患者的预后情况,分析不良预后的危险因素。方法:2009年至2011年在全国20家医院连续入选急诊就诊、年龄≥75岁房颤患者为本研究对象,收集患者基线资料和治疗情况,并进行1年随访,主要终点事件为全因死亡,次要终点事件为心血管死亡、卒中、大出血事件及主要不良事件。应用单因素和多因素Cox回归模型分析上述事件的独立危险因素。结果:共入选766例老年急诊房颤患者,年龄(80.76±4.66)岁,女性占56.9%。1年的全因病死率为24.3%,心血管病死率为12.8%,卒中发生率为10.6%,主要不良事件发生率33.6%,再入院率32%。多因素Cox回归模型分析显示年龄（ HR1.073,95% CI 1.042~1.105）、心率（ HR 1.008,95% CI 1.002~1.013）、痴呆/认知障碍史（ HR 1.849,95% CI 1.016~3.365）、既往慢性阻塞性肺疾病史（ HR 1.824,95% CI 1.303~2.551）为老年房颤患者1年死亡的独立危险因素。女性（ HR 1.664,95% CI 1.036~2.675）、高血压病史（ HR 2.035,95% CI 1.080~3.836）、痴呆/认知障碍史（ HR 2.773,95% CI 1.220~6.302）、为老年房颤患者1年卒中的独立危险因素。 结论:老年急诊房颤患者的预后较差,年龄、心率、痴呆/认知障碍史、慢性阻塞性肺疾病史是老年急诊房颤患者1年全因死亡和主要不良事件的独立危险因素;女性、高血压病史、痴呆/认知障碍史为老年急诊房颤患者1年卒中的独立危险因素。     

An evaluation of risk factors for adverse drug events associated with angiotensin-converting enzyme inhibitors

RATIONALE, AIMS AND OBJECTIVES: To identify potential factors leading to discontinuation of angiotensin-converting enzyme (ACE) inhibitors because of adverse drug events. METHODS: Retrospective cohort study was conducted at outpatient clinics affiliated with an urban tertiary care hospital. ACE inhibitors were administered to 2225 consecutive outpatients. RESULTS: In 19% of the total cohort, ACE inhibitors were discontinued because of adverse drug events. Cox proportional hazard model identified the following independent risk factors for discontinuation because of adverse drug events: age, female gender, ethnicity other than African American or Latino, no history of previous ACE inhibitor use, history of cough caused by another ACE inhibitor, hypertension, anxiety or depression, no hemodialysis, and elevated creatinine. History of smoking was shown to be a risk factor for cough [hazard ratio (HR): 2.5; 95% confidence interval (CI): 1.1-5.7], angioedema (HR: 2.7; 95% CI: 1.1-7.0), and hyperkalaemia (HR: 5.4; 95% CI: 1.3-23.2). History of ACE inhibitor-induced cough was not only a risk factor for cough (HR: 12.9; 95% CI: 7.5-22.3) but also for angioedema (HR: 9.1; 95% CI: 2.1-39.9). Patients with creatinine > or = 1.6 mg dL(-1) were likely to discontinue ACE inhibitors because of renal dysfunction (HR: 4.7; 95% CI: 1.5-12.7) and hyperkalaemia (HR: 10.9; 95% CI: 3.1-39.0). East Asians were more likely to develop cough (HR: 2.5; 95% CI: 1.1-5.7) and hyperkalaemia (HR: 80.3; 95% CI: 5.4-1190) and African Americans to develop angioedema (HR: 3.5; 95% CI: 1.3-8.9). CONCLUSIONS: Although further validation is necessary, these risk factors should help doctors identify patients with elevated risk for adverse drug events because of ACE inhibitors.     

An angiotensin-converting enzyme gene polymorphism suggests a genetic distinction between ischaemic stroke and carotid stenosis

BACKGROUND: Ischaemic cerebrovascular disease (ICVD) is a heterogeneous syndrome to which different genetic factors may contribute. We have investigated the distribution of alleles of the angiotensin-converting enzyme (ACE) gene, which has been suggested to be of possible importance in ischaemic stroke or cardiovascular disease, in groups of patients with ischaemic stroke and carotid artery stenosis (CS). MATERIALS AND METHODS: One hundred and thirty patients with ischaemic stroke and 68 patients with more than 50% stenosis of the internal carotid artery were investigated and compared with age- and sex-matched healthy control subjects. Alleles of an insertion/deletion polymorphism of the ACE gene were determined by one-stage polymerase chain reaction and visualized on agarose gels. RESULTS: There was a significant difference (P < 0.05) in the distribution of ACE alleles, homozygosity for the presumed susceptibility deletion allele being more common in patients with CS than in healthy control subjects. There was also a significant difference (P < 0.05) in patients with CS in comparison with matched ICVD patients without CS, both in allelic frequencies and in homozygosity for the deletion allele. CONCLUSIONS: Our results indicate that the ACE gene polymorphism may be a risk factor for the development of CS. The observed difference in ACE allele distribution may be seen as evidence for a genetic distinction between ICVD and CS, two clinically related conditions, which further supports the hypothesis that genetic factors are of importance for this group of diseases.     

Change in activity of angiotensin-converting enzyme in pneumonia and chronic obstructive lung diseases

AIM: To study the activity of angiotensin-converting enzyme (ACE) in patients with pneumonia and chronic obstructive lung diseases (COLD). MATERIAL AND METHODS: Sixty nine patients with pneumonia and 77 with COLD were examined. The activity of ACE in the serum and bronchoalveolar lavage (BAL) and the effects of leukocytic elastase and concentrations of zinc, endogenous inhibitors, and activators were studied. RESULTS: The patients with pneumonia in the acute phase of the disease have been found to have low ACE activity in both blood and BAL. As the inflammatory process comes to an end, ACE activity normalizes. In the patients with COLD, the activity of ACE is primarily decreased at remission. When COLD aggravates, the activity of ACE in blood and BAL increases. In pneumonia and COLD, the changes in ACE activity are more profound in BAL than in blood. CONCLUSION: The only cause of the altered activity of ACE in patients with COLD and pneumonia is a change in the concentration of the enzyme.     

高龄卒中后高血压患者的临床特征与危险因素分析

目的 探讨高龄卒中后高血压患者的临床特征和危险因素。方法 回顾性分析300例高龄脑卒中住院患者的临床资料，比较不同性别、年龄、病变患者的血压变化，分析高龄卒中患者的临床特点与血压变化规律，探讨其影响因素。结果 高龄组患者的肢体瘫痪、意识障碍发生率高，头痛、呕吐发生率低；卒中后高血压以中、重度为主，收缩压升高明显；危险因素中高血压、糖尿病、吸烟、酗酒比例降低，冠心病比例增高，肺部感染比例明显增高。结论 高龄卒中患者的危险因素与非高龄患者不同，有其独特的卒中后血压变化规律与临床特征。     

老年人脑血管功能分析与卒中危险度评估

目的:分析和评估老年人的脑血管功能、卒中危险度、危险因素暴露状况,描述其人群分布特征。方法:以现况研究设计,整群抽取社区人群中>60岁及60岁以上的老年人群1827人,进行卒中危险因素调查和脑血管血液动力学指标(CVHI)检测。描述卒中危险因素暴露、CVHI检测指标及其积分值的人群分布特征,评估卒中危险度。结果:高血压病、心脏病、肥胖和吸烟的暴露率在男性分别为41.1%、9.4%、1.8%和86.1%,在女性分别为49.6%、13.6%、3.7%和0.46%,上述因素及多项CVHI在男、女组间均有显著差异(P<0.05);高血压病和心脏病的暴露率、收缩压水平随年龄增长而上升,体质量指数(BMI)和CVHI积分值随年龄增长而下降(P<0.01);卒中危险度上升至5倍、7倍和14倍者男性分别为11.3%、11.5%、8.5%,女性分别为17.7%、11.9%、9.9%。结论:老年人的卒中危险因素暴露存在年龄和性别分布差异,高血压暴露率最高,约1/3左右的老年人脑血管功能明显受损,卒中风险明显上升。     

A history of migraine is not a risk factor to develop an ischemic stroke in the elderly

OBJECTIVE: To assess the prevalence of migraine in elderly patients hospitalized with ischemic stroke compared with vascular and nonvascular control groups. BACKGROUND: Migraine is a disease with a presumed vascular mechanism. While migraine is a common complaint of young victims of ischemic stroke, it is unclear whether a current or past history of migraine constitutes a risk factor for developing an ischemic stroke in the elderly. METHODS: We obtained current and past headache history from 100 consecutive patients hospitalized with ischemic stroke (aged 60 years or older) and compared the results with 100 patients hospitalized due to acute myocardial infarction and 100 hospitalized patients with no vascular disease. RESULTS: The sex and the age of the patients did not differ among the groups. The lifetime prevalence of migraine (8% of the patients with ischemic stroke, 8% of the nonvascular controls, and 15% of the patients with acute myocardial infarction) or of all types of headaches (27%, 30%, and 15%, respectively), did not differ significantly between the groups. CONCLUSIONS: Based on the reported history, elderly migraineurs are not at increased risk to develop ischemic stroke.