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目的探讨慢性阻塞性肺疾病(COPD)患者医院获得性肺炎(HAP)的危险因素。方法回顾性分析COPD合并HAP患者43例(病例组)和COPD未发生HAP患者77例(对照组)的临床资料。采用单因素分析及多因素Logistic回归分析COPD患者HAP的相关危险因素。结果单因素分析筛选出HAP的8项可能危险因素:年龄≥75岁、入住呼吸科重症监护病房(RICU)、住院时间超过30d、呼吸衰竭、低蛋白血症、气管插管机械通气、全身激素的应用、先前应用>2种广谱抗生素。多因素Logistic回归分析显示,先前应用>2种广谱抗生素、全身激素的应用、入住RICU是COPD患者HAP的独立危险因素。结论合理应用激素及抗菌药物,加强RICU管理是降低呼吸科病房COPD患者HAP发生的关键。
Objective To investigate the risk factors of hospital acquired pneumonia (HAP) in patients with chronic obstructive pulmonary disease (COPD). Methods The clinical data of 43 patients with COPD complicated with HAP (case group) and 77 HAP patients without COPD (control group) were retrospectively analyzed. Univariate analysis and multivariate logistic regression analysis were used to analyze the risk factors associated with HAP in COPD patients. Results Univariate analysis identified 8 possible risk factors for HAP: age ≥75 years, admission to the respiratory intensive care unit (RICU), hospitalization for more than 30 days, respiratory failure, hypoalbuminemia, endotracheal intubation and mechanical ventilation Applications, previous applications> 2 broad spectrum antibiotics. Multivariate logistic regression analysis showed that the application of> 2 broad-spectrum antibiotics, systemic hormones and RICU admission were independent risk factors for HAP in COPD patients. Conclusion The rational use of hormones and antimicrobial agents to strengthen RICU management is the key to reduce HAP in patients with COPD in respiratory ward.