老年呼吸机相关性肺炎患者发生心血管事件的影响因素
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(1.贵州医科大学第三附属医院 急诊医学科,贵州 都匀 558005;2.贵州医科大学第三附属医院 重症医学科,贵州 都匀 558005)

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Influencing factors of cardiovascular events in elderly patients with ventilator-associated pneumonia
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(1. Department of Emergency Medicine,Duyun 558005, Guizhou Province, China ;2. Department of Critical Care Medicine, Third Affiliated Hospital of Guizhou Medical University, Duyun 558005, Guizhou Province, China)

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    【摘要】目的 分析老年呼吸机相关性肺炎(VAP)患者发生心血管事件(CVE)相关因素。方法 回顾性调查2017年1月至2020年9月于贵州医科大学第三附属医院发生的297例VAP患者临床资料,根据是否发生CVE分为CVE组与非CVE组,并对可能影响发生CVE的相关因素进行分析。采用SPSS 25.0软件进行数据分析。根据数据类型,组间比较分别采用χ2检验或者t检验。采用logistic模型进行多因素回归分析。结果 297例老年VAP患者发生CVE 104例(35.02%),未发生CVE 193例(64.98%)。发生CVE老年VAP中以并发新发心力衰竭、新发心力衰竭+房性心动过速与心力衰竭恶化多见。logistic回归模型分析显示,慢性心血管病病史、急性生理学及慢性健康状况评分、血糖、血肌酐和降钙素原等是老年VAP患者发生CVE的独立危险因素(P<0.05),发生VAP后拔管时机(立即)、体位(半卧位)、动脉血pH、根据药敏试验选用抗菌药物是老年VAP患者发生CVE的独立保护因素(P<0.05)。结论 需重点关注慢性心血管病病史与危重患者治疗,抗感染治疗、控制血糖、保护肾功能及调节酸碱平衡可减少老年VAP患者并发CVE。

    基金项目:贵州省科技厅联合项目(黔科合LH字[2014]7162号);贵州省黔南州社会发展科技项目(黔南科合社字[2018]7号)

    【Abstract】Objective To analyze the related factors for cardiovascular events (CVE) in the elderly patients with ventilator-associated pneumonia (VAP). Methods The clinical data of 297 elderly VAP patients admitted in our hospital from January 2017 to September 2020 were collected and retrospectively investigated. They were divided into CVE group and non-CVE group according to whether CVE occurred, and the related factors that may affect the occurrence were analyzed. SPSS statistics 25.0 was used for statistical analysis. Chi-square test or student′s t test was performed for data comparison between 2 groups depending on date types. Logistic multivariate regression analysis was applied for further analysis. Results Among the 297 elderly VAP patients, 104 (35.02%) experienced CVE, and 193 (64.98%) did not. In the elderly VAP patients with CVE, new onset heart failure, new onset heart failure+atrial tachycardia, and deterioration of heart failure were quite common. Logistic regression analysis showed that the history of chronic cardiovascular disease, acute physiology and chronic health evaluation scoring system score, blood glucose, serum creatinine, procalcitonin were independent risk factors for CVE in elderly VAP patients (P<0.05). The timing of extubation (immediately), body position (semi-recumbent position), arterial blood pH value and antibiotics selection based on drug sensitivity test were the independent protective factors for CVE in elderly VAP patients (P<0.05). Conclusion Attention should be paid to the elderly with the history of chronic cardiovascular disease and in critical condition. Anti-infective treatment, blood glucose control, protection of kidney function, and maintenance of acid-base balance can reduce the incidence of CVE in elderly VAP patients.

    This work was supported by the Joint Project of Guizhou Provincial Department Science and Technology ( LH - 2014 - 7162) and the Science and Technology Project of Social Development of Qiannan, Guizhou Province (2018-07).

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谢朝云,韦波,阳艳.老年呼吸机相关性肺炎患者发生心血管事件的影响因素[J].中华老年多器官疾病杂志,2021,20(8):595-599

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  • 收稿日期:2020-11-04
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  • 在线发布日期: 2021-08-30
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