上海某医院老年患者非呼吸机相关性医院获得性肺炎的流行病学特征及危险因素分析

Epidemiological characteristics and risk factors of non-ventilator associated hospital acquired pneumonia in elderly patients in a hospital in Shanghai

中文关键词: 老年  非呼吸机相关性医院获得性肺炎  流行病学  危险因素

英文关键词: elderly  non-ventilator associated hospital acquired pneumonia  epidemiology  risk factor

中文摘要:

      目的 探讨分析老年住院患者非呼吸机相关性医院获得性肺炎(non-ventilator associated hospital acquired pneu-monia,NV-HAP)的流行病学特征和发病危险因素,为临床预防NV-HAP提供参考.方法 采用描述性流行病学方法,分析2020 年1 月—2021 年12 月上海某三甲医院住院治疗的老年患者中发生NV-HAP的病例的三间分布,采用病例对照研究,从同期未发生NV-HAP的老年住院患者中随机选择对照组,按照1∶2频数匹配,进行卡方检验、Mann-Whitney U检验和二元多因素Logistic回归分析.结果 2020 年1 月—2021 年12 月本院老年住院患者NV-HAP的总发病率为0.66%,发病密度为0.71 例/1 000 人日.男性、女性NV-HAP总发病率分别为 0.76%和 0.54%,两者差异有统计学意义(χ2= 7.890,P =0.005),发病密度分别为0.83 例/1 000 人日和0.57 例/1 000 人日,发病密度随着年龄增长呈上升趋势,其中85～89 岁发病密度最高(1.27 例/1 000 人日);2021 年NV-HAP总发病率较2020 年有下降(χ2 =21.524,P＜0.001),且NV-HAP发病密度在2021 年呈下降趋势;NV-HAP发病科室分布差异较大,ICU、神经外科及神经内科发病密度较高.危险因素分析显示,年龄、长期卧床、意识障碍、血清白蛋白、合并心功能不全、合并CNS疾病、合并恶性肿瘤、使用质子泵抑制剂、使用CNS抑制剂、留置深静脉导管、留置鼻胃管等因素差异有统计学意义,OR值分别为1.046、5.540、27.829、0.148、4.935、2.657、2.995、2.028、2.452、1.900 以及3.771.结论 2020 年1 月—2021 年12 月老年患者NV-HAP发病密度为0.71 例/1 000 人日,发病有性别、年龄、科室差异,ICU、神经外科、神经内科等重点科室的男性高龄患者是高风险人群.年龄、长期卧床以及使用CNS抑制剂、留置鼻胃管等用药及诊疗操作是老年患者发生NV-HAP的危险因素,血清白蛋白水平为保护因素.临床上应该对高危患者进行重点关注,对可变危险因素及早进行干预,以降低NV-HAP发生风险.

英文摘要:

      Objective To explore the epidemiological characteristics and risk factors of non?ventilator associated hospi? tal acquired pneumonia (NV?HAP) in elderly inpatients, and provide reference for clinical prevention of NV?HAP. Methods Descriptive epidemiological methods were used to analyze the distribution of NV?HAP cases among elderly patients hospitalized in a grade III hospital in Shanghai from January 2020 to December 2021. Then a case?control study was conducted to randomly select a control group from elderly hospitalized patients who did not develop NV?HAP during the same period. According to 1∶ 2 frequency matching, Chi?square test, Mann?Whitney U test and binary multi?factor logistic regression analysis were per? formed. Results From January 2020 to December 2021, the total incidence of NV?HAP among elderly inpatients in the hospi? tal was 0. 66% , and the incidence density was 0. 71 cases / 1 000 person?days. The total incidence of NV?HAP in males and females was 0. 76% and 0. 54% , respectively, and the difference was statistically significant ( c2 =7. 890, P =0. 005); the in? cidence densities were 0. 83 cases / 1 000 person?day and 0. 57 cases / 1 000 person?day, respectively. The incidence density shows an increasing trend with age, and the highest incidence density was found in the group of 85?89 years old (1. 27 cases / 1 000 person?days). The incidence of NV?HAP in 2021 was lower than that in 2020 ( c2 =21. 524, P <0. 001), and the inci? dence density of NV?HAP showed a decreasing trend in 2021. The distribution of NV?HAP incidence varied greatly among de? partments, with a higher incidence density in ICU, neurosurgery, and neurology. Risk factor analysis showed that age, long? term bedridden, consciousness disorders, albumin levels, concomitant heart failure, concomitant CNS disease, concomitantmalignant tumors, use of proton pump inhibitors, use of CNS inhibitors, indwelling deep venous catheters, and indwelling na? sogastric tubes were statistically significant. Their OR values were 1. 046, 5. 540, 27. 829, 0. 148, 4. 935, 2. 657, 2. 995, 2?? 028, 2. 452, 1. 900, and 3. 771, respectively. Conclusion From January 2020 to December 2021, the incidence density of NV?HAP in elderly patients was 0. 71 cases / 1 000 person?days, with differences in gender, age, and department. Male elderly patients in key departments such as ICU, neurosurgery, and neurology are at high risk. Age, long?term bedridden, use of CNS inhibitors, indwelling nasogastric tubes, and other medication and diagnostic operation are risk factors for NV?HAP in elderly patients, while albumin was a protective factor. In clinical practice, special attention should be paid to high?risk patients and early intervention of modifiable risk factors should be conducted to reduce the risk of NV?HAP.