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老年冠心病合并心力衰竭患者院内感染的临床特点<br />及相关因素分析

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摘要:

目的 探讨老年冠状动脉粥样硬化性心脏病(冠心病)合并心力衰竭(心衰)患者院内感
染的临床特点及相关因素分析。方法 收集2018年1月至12月于解放军总医院第一医学中心(以下简称
我中心)收治的130例老年冠心病合并心衰患者的临床资料,记录并统计发生院内感染患者的临床特点
(感染部位、病原菌种类和构成比等)及相关影响因素(住院时间、使用激素、侵入性操作、抗菌药
物、病变血管支数等),探讨院内感染防控对策。结果 130例患者中发生感染40例,其中呼吸系统感染
15例,泌尿系统感染12例,消化系统感染8例,血液系统感染5例。40例感染患者中,培养病原菌63株,
其中革兰阴性菌36株(57.14%);革兰阳性菌22株(34.92%);真菌5株(7.94%)。单因素分析结果显
示,住院时间、使用激素、侵入性操作、抗菌药物、病变血管等因素均是患者发生院内感染的相关性因
素(P<0.05);多因素Logistic回归分析结果显示,住院时间、侵入性操作、多支病变血管等因素是患
者院内感染的相关性因素(P<0.05)。结论 老年冠心病合并心衰患者其发生院内感染的部位,主要是
呼吸系统,主要病原菌为革兰阴性菌,相关因素为住院时间、侵入性操作、多支病变血管。治疗中,应
加强对合理使用抗菌药物,严格无菌操作,减少侵入性操作时长和次数,加强营养支持和护理干预,从
而降低院内感染发生几率。

Abstract:

Objective To investigate the clinical characteristics and relevant factors of nosocomial infection
in elderly patients with coronary heart disease (CHD) complicated by heart failure (HF). Methods The clinical
materials were collected from the elderly patients with CHD complicated by HF (n=130) treated in the First Medical
Center of Chinese PLA General Hospital from Jan. 2018 to Dec. 2018. The clinical characteristics (infection sites,
types and composition ratio of pathogens, etc.), and relevant factors (length of hospital stay, use of hormones,
invasive procedures, antibiotics, number of diseased blood vessels, etc.) were recorded and treated statistically in the
patients with nosocomial infection. The countermeasures of controlling nosocomial infection were discussed. Results
Among 130 patients, 40 cases suffered from infection, including 15 cases of respiratory system infection, 12 cases of
urinary system infection, 8 cases of digestive system infection and 5 cases of blood system infection. In 40 infected
patients, there were 63 strains of pathogenic bacteria cultured, including 36 strains of Gram-negative bacteria
(57.14%), 22 strains of Gram-positive bacteria (34.92%) and 5 strains of fungi (7.94%). The results of singlefactor
correlation analysis showed that length of hospital stay, use of hormones, invasive procedures, antibiotics and
diseased blood vessels were relevant factors of nosocomial infection (P<0.05). The results of Logistic regression
analysis showed that length of hospital stay, invasive procedures and multiple diseased blood vessels were relevant
factors of nosocomial infection (P<0.05). Conclusion The site of nosocomial infection is mainly respiratory system,
major pathogenic bacteria is Gram-negative bacteria, and relevant factors are length of hospital stay, invasive
procedures and multiple diseased blood vessels. In the treatment, it is necessary to strengthen rational application
of antibiotics and sterile technique, cut down the duration and frequency of invasive operations, enhance nutritional
support and nursing intervention and reduce the incidence rate of nosocomial infection.

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