康复病房住院患者医院获得性肺炎病原学及危险因素分析

摘要

Objective To investigate the pathogen′s distribution and risk factors of hospital-acquired pneu-monia(HAP)in rehabilitation department.Methods The clinical data of 1 648 patients in rehabilitation de-partment during April 2012 to June 2016 were retrospective collected to analyze the pathogenic characteristics and relative risk factors of HAP.Results Among the 1 648 patients,a total of 116 cases were diagnosed with HAP,of which the incidence rate was 7.04%.The pathogenic bacteria were mainly gram-negative bacteria,ac-counting for 64.80%,followed by gram-positive bacteria,accounting for 26.40%.Univariate analyses showed that,there were significant associations between HAP and age,hospital stays,respiratory disease,cerebrovas-cular disease,diabetes,conscious disturbance,nutritional status,extra-pulmonary infection,smoking,usage of prophylactic antibiotics,invasive operation.M ultivariate analysis suggested that older than 60,respiratory dis-ease,cerebrovascular disease,diabetes,nutritional status,smoking,usage of prophylactic antibiotics,and inva-sive operation were the independent risk factors of HAP in the rehabilitation ward(P<0.05).Conclusion The incidence of HAP in rehabilitation department was relatively high with a wide pathogen′s distribution, and was associated with many factors.Some pertinent measures should be conducted to intervene in these risk factors and reduce the incidence of HAP.%目的 探讨康复病房住院患者医院获得性肺炎(HAP)的病原菌分布及危险因素.方法 回顾性收集2012年4月至2016年6月在该院康复科1648例住院患者的临床资料,对HA P的病原学特点及相关危险因素进行分析.结果 1648例患者中,共有116例发生HA P,发生率为7.04%;病原菌以革兰阴性菌为主,占64.80%,其次为革兰阳性菌,占26.40%.单因素分析结果显示,HA P与年龄、住院时间、并发呼吸系统疾病、并发脑血管疾病、并发糖尿病、并发意识障碍、营养状况、并发肺外感染、吸烟、质子泵抑制剂、预防性抗菌药物、侵入性操作等因素存在着关联性.多因素Logistic回归分析结果显示,年龄>60岁、并发呼吸系统疾病、并发脑血管疾病、并发糖尿病、营养状况较差、吸烟、预防性抗菌药物、侵入性操作等是康复病房患者发生HAP的独立危险因素(P<0.05).结论 康复病房住院患者 H A P的发生率较高,并且病原菌分布较广,并与多种因素有关,在临床工作中应针对这些因素进行必要的干预,以减少HAP的发生.