曾美娥 叶水芬 邹碧兰 丘汉忠

[摘要] 目的 分析老年COPD患者肺部感染的影响因素。方法 回顾性分析该院2017年3月—2019年5月期间收治的826例老年COPD患者临床相关资料，采集患者清晨呼吸道深部新鲜痰液，行痰涂片培养，明确肺部感染情况，根据患者肺部感染情况分为感染组（n=87）和未感染组（n=739），分析肺部感染相关影响因素。结果 826例患者中有87例发生肺部感染（10.53%），共检出115株菌株，其中革兰氏阴性菌为主（58.26%），革兰氏阳性菌（33.04%）;感染组有糖尿病史、有创机械通气、静脉激素使用时间≥10 d、抗菌药物种类≥2种及Ⅱ型呼吸衰竭发生率均较未感染组高，差异有统计学意义（P<0.05）;经多因素Logistic回归分析显示，患者有糖尿病史、有创机械通气、静脉激素使用时间≥10 d、抗菌药物种类≥2种及Ⅱ型呼吸衰竭均是影响老年COPD患者肺部感染独立危险因素（OR>1，P<0.05）。结论 根据老年COPD患者肺部感染独立危险因素，制定临床防治方案，可提高患者预后。

[关键词] 慢性阻塞性肺疾病;肺部感染;影响因素

[Abstract] Objective To analyze the influencing factors of pulmonary infection in elderly patients with COPD. Methods The clinical data of 826 elderly patients with COPD treated in the hospital from March 2017 to May 2019 were retrospectively analyzed. Fresh sputum from the deep part of the respiratory tract in the morning was collected， and sputum smear culture was performed to determine the status of pulmonary infection. Pulmonary infections were divided into infected group （n=87） and uninfected group （n = 739）. Factors related to pulmonary infection were analyzed. Results Among the 826 patients， 87 cases had lung infection （10.53%）， and 115 strains were detected， of which Gram-negative bacteria were dominant （58.26%） and Gram-positive bacteria（33.04%）;the infection group had the history of diabetes， invasive mechanical ventilation， venous hormone use time≥10 d， antibacterial drugs ≥2 types， and the incidence of type Ⅱ respiratory failure were higher than those in the uninfected group， and the differences were statistically significant （P<0.05）; multivariate logistic regression analysis showed that patients with a history of diabetes， invasive mechanical ventilation， venous hormone use time ≥10 d， antibacterial drugs ≥2 types， and type Ⅱ respiratory failure were independent risk factors affecting lung infection in elderly patients with COPD（OR>1，P<0.05）. Conclusion Based on independent risk factors for pulmonary infection in elderly COPD patients， formulating clinical prevention and treatment programs can improve the prognosis of patients.

[Key words] Chronic obstructive pulmonary disease; Pulmonary infection; Influencing factors

慢性阻塞性肺疾病（COPD）屬于慢性疾病，多发于老年群体，具有病程长、发病率高、病死率高等特点，患者常伴有慢性咳嗽、胸闷、喘息、咳痰、呼吸困难等症状，其发生与有害气体及颗粒的异常炎症有关，可能引发肺心病、心力衰竭等，甚至造成患者死亡[1-3]。基于此，该文主要研究回顾性分析该院2017年3月—2019年5月期间收治的826例老年COPD患者临床相关资料，分析COPD患者肺部感染的影响因素，现报道如下。

1  资料与方法

1.1  一般资料

回顾性分析该院收治的826例老年COPD患者临床相关资料，其中男564例，女262例;年龄60～84岁，平均（71.83±6.14）岁;病程3～25年，平均（14.26±2.34）年。所有患者经过伦理委员会批准，患者及其家属都知情同意。

1.2  纳入与排除标准

纳入标准：①患者均符合COPD诊断标准[4];②所有患者临床资料完整。排除标准：①合并自身免疫性疾病者;②合并心、肝、肾等功能不全者。……