住院老年人吸入性肺炎患病率及其危险因素分析

摘要

目的 探讨老年住院患者吸入性肺炎患病率及其危险因素,识别误吸高危人群. 方法 横断面研究,选取2014年4月至2015年4月北京医院收治的住院老年患者398例,通过问卷调查采集患者年龄、性别、吸烟饮酒史、吞咽功能、基础疾病、用药史、日常生活活动能力(ADL)评分、过去1年内吸入性肺炎发生情况等资料,根据过去1年内有无发生吸入性肺炎分为吸入性肺炎组和非吸入性肺炎组,分析住院老年患者吸入性肺炎患病率及其危险因素. 结果 364例患者资料完整,52例(14.3％)在过去1年内发生吸入性肺炎.吸入性肺炎组患者[(77.0±33.9)分]与非吸入性肺炎组患者ADL评分[(88.0±22.2)分]比较,差异有统计学意义(P＜0.05).吸入性肺炎组患者随年龄增加,吸入性肺炎发生比例升高,60～69岁、70～79岁、≥80岁患者吸入性肺炎发生比例分别为23.1％(12例)、36.5％(19例)、40.4％(21例),不同年龄段患者吸入性肺炎危险因素不同.两组患者1∶1倾向评分匹配后行Logistic多因素回归分析结果显示,吸烟、冠心病、帕金森病、老年性痴呆、慢性阻塞性肺疾病、胃食管反流病、长期服用茶碱、钙离子拮抗剂、硝酸酯类药物、安定镇静剂、抗抑郁药、抗帕金森药为老年患者发生吸入性肺炎的危险因素(均P＜0.05). 结论 老年人发生吸入性肺炎与吸烟、基础疾病、用药史等因素有关,应重视评估患者存在的误吸危险因素,制定相应的预防措施以降低老年人吸入性肺炎的发生率.%Objective To analyze the prevalence rate and risk factors for aspiration pneumonia in elderly inpatients,and to identify a high-risk population for aspiration pneumonia.Methods Totally 398 inpatients aged ≥ 60 years in Beijing Hospital from April 2014 to April 2015 were selected.A questionnaire survey was performed for aspiration risk factors,including gender,age,smoking and drinking history,swallowing function,basal diseases,medication history,activities of daily living(ADL),occurrence of aspiration pneumonia over the past year.The patients were divided into aspiration pneumonia group and non-aspiration pneumonia group,and the prevalence rate and risk factors for aspiration pneumonia were studied.Results 364 cases with complete data were collected,and 14.3％ (52/364)were identified definitively as aspiration pneumonia over the past year.The ADL score was (77.0± 33.9) scales in aspiration pneumonia group,and (88.0 ± 22.2) scales in non-aspiration pneumonia group,with statistically significant difference (P＜ 0.05).The incidence rate of aspiration pneumonia was increased along with the increase of the age of patients.Risk factors for aspiration pneumonia were different in different age group.The proportion of patients aged 60-69,70-79 and over 80 years were 23.1％ (12 cases),36.5％ (19 cases),40.4％ (23 cases)in the aspiration pneumonia group,respectively.Under the condition of a propensity score-matched case-control pair design on 104 subjects with versus without aspiration pneumonia,the logistic regression analysis showed that smoking history,coronary heart disease,Parkinson's disease,dementia,chronic obstructive pulmonary disease(COPD),gastro-esophageal reflux disease(GERD),long-term uses of theophylline,calcium antagonists,nitrates,diazepam,antidepressants,anti-Parkinson drugs were the risk factors for aspiration pneumonia in elderly(all P＜0.05).Conclusions Smoking history,basal diseases and medication history are associated with the incidence rate of aspiration pneumonia in elderly.Assessment of these risk factors for aspiration pneumonia should be emphasized,and preventive measures should be considered conscientiously to lower the incidence rate of aspiration pneumonia in elderly.