老年COPD患者并发肺部感染的影响因素及预防对策

目的分析老年慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）患者并发肺部感染的影响因素,并探讨预防对策。方法回顾性分析我院呼吸科于2011年5月~2013年5月收治的1 105例老年COPD患者,按照其肺部感染发生情况分为感染组（n=117）及未感染组（n=988）,对比两组患者一般资料,分析影响因素,并对感染组患者进行病原学分析,探讨预防对策。结果 1 105例患者中共发现117例并发肺部感染,发生率10.6%;多因素回归分析发现,有糖尿病史、行机械通气、长期使用激素、长期使用抗菌药物及Ⅱ型呼吸衰竭是影响老年COPD患者并发肺部感染的独立危险因素（P〈0.05）;感染菌中主要革兰阴性菌对碳青霉烯类、内酰胺/酶抑制剂类抗菌药物可维持较好的药物敏感性;主要革兰阳性菌对万古霉素维持较好的药敏性。结论上述因素对老年COPD患者肺部感染的发生具有明显影响,应采取推广有效排痰方法、规范抗菌药物的应用、遵守无菌原则、实施营养支持等方法,改善患者免疫功能,降低其感染发生率,以保证患者的生活质量和生存预期。

Influencing Factors in Elderly COPD Patients Complicated with Pulmonary Infection and the Preventive Measures

Objective To analyze influencing factors in the elderly patients of chronic obstructive pulmonary disease（COPD）complicated with pulmonary infection,and to explore the preventive countermeasures.Methods A retrospective analysis was performed using 1 105 cases of elderly patients with COPD from department of respiration of Chongzhou People＇s Hospital,from May 2011-May 2013.The patients were divided into infection group（n=117）and non-infection group（n=988）based on the incidence of pulmonary infection.The general information and influencing factors of infection patients were compared,pathogenic and countermeasure analysis for the infection group was executed.Results 117 cases of pulmonary infection were found from 1 105 patients with COPD（incidence of 10.6%）;multi factor regression analysis showed that factors including diabetes,mechanical ventilation,the use of hormones,long-term use of antibiotics and type II respiratory failure were the independent risk factors for the occurrence of pulmonary infection in elderly patients with COPD（P〈0.05）;drug sensitivity analysis demonstrated that the main gram negative bacteria maintained sensitive to carbapenems,lactam/enzyme inhibitor class of antimicrobial agents,and the main gram positive bacteria could be sensitive to vancomycin.Conclusion The above factors have obvious influence on elderly COPD patients with pulmonary infection.To ensure the quality of life of patients and prolong the survival expectation,countermeasures that include promoting the effective expectoration,standardizing the application of antibacterials,obeying the aseptic principles,nutrition support,improving the immune function of patients and reducing the incidence of infection,all should be taken in practice.