老年心臟介入術后肺部感染相關危險因素分析及護理對策

張靈芝

[摘要]目的 探討老年心臟介入術后肺部感染的危險因素及護理對策。方法 選取2014年1月～2016年10月在本院行心臟介入治療的老年患者329例作為研究對象，根據患者術后是否發生肺部感染分為感染組（n=22）和未感染組（n=307），對兩組患者的臨床資料進行回顧分析，并采用Logistic回歸分析法分析造成肺部感染的危險因素。結果 329例患者中發生肺部感染22例，感染率為6.69%。感染組與肺感染組患者在吸煙、肺功能分級、精神狀態、術后下床活動時間及術后服用抗生素方面差異有統計學意義（P<0.05），而在年齡、性別、體質量、高血壓、糖尿病、手術方式及心功能分級方面均無統計學差異（P>0.05）；Logistic回歸分析，結果顯示吸煙、肺功能分級、精神狀態、術后下床活動時間均是心臟介入術后肺部感染的主要影響因素（P<0.05）。結論 老年患者心臟介入治療后并發肺部感染的影響因素較多，長期吸煙、肺功能差、抑郁焦慮及長期臥床均與肺部感染有關，應采取相應護理措施，降低肺部感染的發生風險。

[關鍵詞]老年；心臟介入術；肺部感染；危險因素；護理對策

[中圖分類號] R473 [文獻標識碼] A [文章編號] 1674-4721（2017）06（a）-0149-04

[Abstract]Objective To explore the risk factors and nursing strategies of pulmonary infection in elderly patients after cardiac intervention.Methods A total of 329 elderly patients were enrolled in our hospital from January 2014 to October 2016 and were divided into infection group （n=22） and non infection group （n=307） according to whether the patients had pulmonary infection after cardiac intervention.The clinical data were retrospective analyzed and logistic regression analysis was used to analyze the risk factors of pulmonary infection.Results There were 22 cases of pulmonary infection in 329 patients，the infection rate was 6.69%.There were significant differences in smoking，pulmonary function classification，mental status，time of bed movement and intake of antibiotics after operation between the infection group and non infection group group （P<0.05），whereas there was no significant difference in age，gender，body weight，hypertension，diabetes mellitus，operation mode and cardiac function grade in two grops （P>0.05）.Logistic regression analysis showed that smoking，pulmonary function classification，mental state，postoperative time of bed movement were the main influencing factors of pulmonary infection after cardiac intervention （P<0.05）.Conclusion Long-term smoking，poor lung function，depression and anxiety and long-term bed rest are related to pulmonary infection，and corresponding nursing measures should be taken to reduce the risk of pulmonary infection in elderly patients after cardiac intervention.

[Key words]Elderly；Cardiac intervention；Pulmonary infection；Risk factors；Nursing strategies

心臟介入治療是一種近年來新興發展起來的心臟手術，該手術具有診斷明確、創傷性小、療效顯著的優點，已成為及藥物治療和外科手術后廣泛應用于臨床的治療手段[1]。隨著我國人均壽命的增長，人口老齡化的加重，心血管疾病的發生率日益增多，心臟介入術的實施量亦隨之增多，據臨床統計顯示我國年均介入手術實施量可達50萬例，同時其帶來的不良反應及術后嚴重并發癥引起較高重視[2]。由于老年患者術前存在較多基礎疾病加之自身功能退化，抵抗力相對較差，術中創傷及術后合并癥的存在使患者術后易產生感染，其中肺部感染是老年患者術后較為嚴重的并發癥，會導致患者預后較差，甚至增加死亡的發生率[3-4]。因此，本研究對我院2014年以來實施心臟介入治療的老年患者的臨床資料進行回顧分析，探討影響術后肺部感染的危險因素，以期為臨床護理提供參考，具體結果報道如下。