高龄肺部感染患者发生吸入性肺炎的临床特点及危险因素

Clinical characteristics and risk factors of aspiration pneumonia in ≥80 years old patients with pulmonary infection

摘要:

目的 分析高龄肺部感染患者发生吸入性肺炎(AP)的临床特点及危险因素。方法 回顾性研究2013年1月至2016年1月在空军军医大学西京医院老年病科住院治疗的高龄(≥80岁)医院获得性肺部感染患者共212例,依据是否发生AP分为2组:AP组(n=61)和非AP组(n=151)。收集患者临床资料,包括性别、年龄、基础疾病、用药史等,分析高龄肺部感染患者发生AP的临床特点及危险因素。采用SPSS 18.0软件进行数据处理。结果 212例高龄肺部感染患者中,61例(占35.4%)发生AP。2组患者痰培养均以革兰氏阴性菌感染为主。AP组住院时间较非AP组[(21.4±2.1)和(15.7±3.1)d]显著延长(P＝0.034),病死率较非AP组显著增高(24.6%和8.0%,P＝0.002)。多因素logistic回归分析发现,年龄大(OR=4.897,95%CI 3.556~7.878)、认知障碍(OR=6.799,95%CI 2.931~9.443)、吞咽功能障碍(OR=8.345,95%CI 1.062~5.133),以及服用抑酸药(OR=4.667,95%CI 4.283~8.343)、镇静药(OR=3.886,95%CI 1.944~7.174)、硝酸酯类药物(OR=3.445,95%CI 2.977~6.437)、钙离子拮抗剂(OR=3.568,95%CI 4.345~7.868)、血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体阻滞剂(ACEI/ARB)(OR=6.876,95%CI 2.192~9.458)是高龄肺部感染患者发生AP的独立危险因素(P＜0.05)。结论 高龄肺部感染患者AP发生率高。年龄大、认知障碍、吞咽功能障碍及服用抑酸药、镇静药、硝酸酯类、钙离子拮抗剂、ACEI/ARB是高龄肺部感染患者发生AP的独立危险因素。

Abstract:

Objective To analyze the clinical characteristics and risk factors of aspiration pneumonia (AP) in very elderly patients with pulmonary infection. Methods A retrospective study was conducted of a total of 212 elderly patients (≥80 years old) with pulmonary infection who were hospitalized in the Geriatric Department of Xijing Hospital from January 2013 to January 2016. They were divided into two groups:AP group (n=61) and non-AP group (n=151). Clinical data of the patients were collected, including gender, age, BMI, underlying diseases, medication history, etc., for the analysis of the clinical characteristics and risk factors of aspiration pneumonia in very elderly patients. SPSS statistics 18.0 was used for data analysis. Results Of the 212 elderly patients with pulmonary infection, 61(35.4%) developed aspiration pneumonia. Sputum cultures were mainly Gram-negative in both groups. The length of hospital stay in the AP group was significantly longer than that in the non-AP group [(21.4±2.1) vs (15.7±3.1)d,P=0.034], and the mortality rate was significantly higher than that in the non-AP group (24.6% vs 8.0%, P=0.002). The subjects in the observation group had more cognitive impairment, swallowing dysfunction, hypothyroidism, and a history of long-term use of angiotensin converting enzyme inhibitor/angiotensin Ⅱ receptor blocker (ACEI/ARB) antihypertensive drugs (P<0.05). Multivariate logistic regression analysis found that advanced age (OR=4.897,5%CI 3.556-7.878), cognitive impairment (OR=6.799,5%CI 2.931-9.443), swallowing dysfunction (OR=8.345,5%CI 1.062-5.133), and acid-suppressing drugs (OR=4.667,5%CI 4.283-8.343), sedatives (OR=3.886,5%CI 1.944-7.174), nitrates (OR=3.445,5%CI 2.977-6.437), calcium antagonist (OR=3.568,5%CI 4.345-7.868), ACEI/ARB (OR=6.876,5%CI 2.192-9.458) were independent risk factors for AP in elderly patients with pulmonary infection (P<0.05). Conclusion [JP+1]The incidence of AP is high in elderly patients. Advanced age,cognitive impairment, swallowing dysfunction and long-term use of ACEI/ARB antacids, sedatives, nitrates, calcium antagonists, and ACEI/ARB antihypertensive drugs are independent risk factors for the occurrence of AP in elderly people with pulmonary infection.