老年癡呆患者發(fā)生院內(nèi)感染的危險(xiǎn)因素及預(yù)防對(duì)策*

□ 孫蕊 SUN Rui

Objective To explore the risk factors of nosocomial infection in elderly patient with Alzheimer's disease, and to put forward corresponding preventive measures. Methods Eighty elderly patients with Alzheimer's disease diagnosed with nosocomial infection were chosen as case group. Eighty elderly patients with Alzheimer's disease without nosocomial infection were randomly selected as control group. A retrospective case-control study was conducted to identify the risk factors of nosocomial infection with Alzheimer's disease using univariate and multivariate screening methods. Results The infections in elderly patients with Alzheimer's disease mainly happened in respiratory system, urinary system and skin tissue. Multivariate analysis showed that the risk factors for nosocomial infection in elderly patients with Alzheimer's disease included mellitus diabetes (OR=3.557), hypoproteinemia (OR=2.983),prolonged bed rest (OR=4.315), unreasonable use of antibacterials (OR=4.764), and invasive procedures (OR=5.387). Conclusion There are many risk factors for nosocomial infection in patients with Alzheimer's disease. Measures should be taken to address the high-risk factors, including treating basic diseases actively, regulating the invasive operations, rationally using antibacterials, and strengthening the care of elderly patients, so as to reduce the incidence of nosocomial infection in patients with Alzheimer's disease.

隨著我國(guó)人民生活水平的提高和人均壽命的延長(zhǎng)，老年癡呆的發(fā)病率也呈現(xiàn)逐年上升的趨勢(shì)。老年癡呆是由于腦組織功能障礙，表現(xiàn)為以智力、行為、人格等功能障礙為特點(diǎn)的綜合征，不僅影響老年患者的生活質(zhì)量，而且給患者家庭及社會(huì)帶來(lái)沉重的負(fù)擔(dān)[1]。中晚期老年癡呆患者多數(shù)需要長(zhǎng)期臥床，自理能力較差，咳嗽反射、吞咽等功能減退，分泌物增多，容易發(fā)生呼吸道等院內(nèi)感染，使之成為院內(nèi)感染的高危人群[2]。為了控制老年癡呆患者的院內(nèi)感染發(fā)生率，需要摸清發(fā)生院內(nèi)感染的相關(guān)危險(xiǎn)因素，并采取相應(yīng)的預(yù)防措施。本研究采用病例對(duì)照的研究方法，分別對(duì)兩組老年癡呆患者進(jìn)行回顧性調(diào)查分析，現(xiàn)將調(diào)查結(jié)果報(bào)告如下。

資料與方法

1.臨床資料。選取2015年1月至2017年9月我院老年病科收治的80例發(fā)生院內(nèi)感染的老年癡呆患者作為研究對(duì)象，患者均符合DSM-IV有關(guān)老年癡呆的診斷標(biāo)準(zhǔn)[3]，而院內(nèi)感染符合衛(wèi)生部2001年頒布的《院內(nèi)感染診斷標(biāo)準(zhǔn)（試行）》中有關(guān)院內(nèi)感染的診斷標(biāo)準(zhǔn)[4]。80例發(fā)生院內(nèi)感染的老年癡呆患者作為病例組，男47例，女33例；年齡75～95歲，平均年齡75.9±4.5歲；病程3-16年，平均7.2±2.9年；病理分型，老年性癡呆45例、血管性癡呆22例、混合型癡呆13例。同期隨機(jī)選取80例未發(fā)生院內(nèi)感染的老年癡呆患者作為對(duì)照組，男41例，女39例；年齡75～96歲，平均年齡83.2±4.9歲；病程2-20年，平均9.0±3.3年；病理分型，老年性癡呆49例、血管性癡呆20例、混合型癡呆11例。兩組患者的性別、年齡、病程、病理分型等基礎(chǔ)資料比較差異無(wú)統(tǒng)計(jì)學(xué)意義(p＞0.05)，具有可比性。……