标题：老年性痴呆患者医院获得性肺炎病原菌分布特点及相关危险因素分析

      作者：何娟 1，王维 1，王刚 2，    (西安市北方医院老年病科 1、普外科 2，陕西 西安 710043)

      卷次： 2018年29卷5期

      【摘要】 目的 探讨老年性痴呆(AD)患者医院获得性肺炎(HAP)发生率、病原菌分布特点，并分析合并HAP发生的危险因素。 方法 回顾性分析 2013年 2月至 2017年 2月西安市北方医院收治的 396例AD患者病历资料，记录AD患者合并HAP的发生率及病原菌分布，并采用多因素Logistic回归分析AD合并HAP的危险因素。 结果 396例AD患者中，86例合并HAP (21.72%)，其中革兰阴性菌占 61.87%，以肺炎克雷伯菌较为常见(20.86%)，其次为铜绿假单胞菌(15.11%)；革兰阳性菌占25.90%，以金黄色葡萄球菌较为常见(13.67%)，真菌感染占7.91%。将AD合并HAP患者作为HAP组，AD未合并HAP患者作为非HAP组，两组年龄、合并糖尿病、合并高血压、侵入性操作、合并吞咽障碍、长期卧床、抗菌药物使用≥2种、住院时间≥30 d比较差异有统计学意义(P<0.05)；Logistic回归分析显示年龄≥80岁、合并糖尿病、侵入性操作、合并吞咽障碍、长期卧床、抗菌药物使用≥2种、住院时间≥30 d是AD患者合并HAP的重要危险因素(P<0.05)。结论 AD患者容易出现HAP，病原菌以革兰阴性菌为主，与年龄、合并糖尿病、侵入性操作、合并吞咽障碍、长期卧床、抗菌药物使用、住院时间等密切相关。
      【关键词】 医院获得性肺炎；老年性痴呆；病原菌；危险因素
      【中图分类号】 R563.1 【文献标识码】 A 【文章编号】 1003—6350（2018）06—0628—03

Distribution of pathogens and related risk factors of hospital acquired pneumonia in patients with Alzheimer'sdisease.
HE Juan 1, WANG Wei 1, WANG Gang 2. Department of Geriatrics 1, Department of General Surgery 2, NorthernHospital of Xi'an City, Xi'an 710043, Shaanxi, CHINA
【Abstract】 Objective To investigate the incidence, distribution of pathogens, and risk factors of hospital ac-quired pneumonia (HAP) in patients with Alzheimer's disease (AD). Methods The medical records of 396 patientswith AD treated in Northern Hospital of Xi'an City from February 2013 to February 2017 were analyzed retrospectively.The incidence of HAP and distribution of pathogens in patients with AD were recorded, and risk factors of HAP in ADwere analyzed by multivariate logistic regression analysis. Results Of the 396 patients with AD, 86 patients (21.72%)had HAP, in which Gram-negative bacteria accounted for 61.87% (mostly Klebsiella pneumonia [20.86%], followed byPseudomonas aeruginosa [15.11% ]), Gram-positive bacteria accounted for 25.90% (mostly Staphylococcus aureus[13.67%]), and fungal infection accounted for 7.91%. Patients with AD and HAP were included in the HAP group, whilepatients with AD and without HAP were included in the non-HAP group. There were significant differences between thetwo groups in age, being complicated with diabetes mellitus, being complicated with hypertension, being complicatedwith invasive operation, being complicated with dysphagia, bedridden time, using more than or equal to 2 kinds of antibi-otics, and hospitalization time longer than or equal to 30 d (P<0.05). Logistic regression analysis showed that age over80 years, being complicated with diabetes mellitus, invasive operation, being complicated with dysphagia, bedriddentime, using more than or equal to 2 kinds of antibiotics and hospitalization time longer than or equal to 30 d were impor-tant risk factors for HAP in patients with AD (P<0.05). Conclusion AD patients are easy to have HAP, and pathogensmainly include Gram-negative bacteria. Pulmonary infection is closely related to age, diabetes mellitus, invasive opera-tion, dysphagia, bedridden time, use of antibiotics and hospitalization time.
      【Key words】 Hospital acquired pneumonia; Alzheimer's disease; Pathogen; Risk factors·论 著·doi:10.3969/j.issn.1003-6350.2018.05.011