高海拔地区慢性阻塞性肺疾病患者病原菌分布及相关因素分析

摘要：目的 探究高海拔地区慢性阻塞性肺疾病（COPD）患者病原菌分布及相关危险因素。方法 选取2016年1月至2019年1月青海省中医院收治的274例COPD患者为研究对象，对患者痰液进行病原菌培养，分析病原菌分布情况及感染多重耐药菌（MDRO）的相关危险因素。结果 274例患者痰液中共培养出致病菌165株，阳性率为60.2%；其中革兰阴性菌占71.5%（118/165），革兰阳性菌占17.0%（28/165），真菌占11.5%（19/165）。单因素分析显示，COPD患者发生MDRO感染与年龄、糖尿病病史、卧床时间、呼吸机污染、机械通气史和频繁更换抗菌药有一定相关性（χ2=8.326、4.868、21.298、5.534、19.686、11.549，均P<0.05），Logistic分析显示，呼吸机污染、机械通气史、频繁更换抗菌药和卧床时间是COPD患者发生多重耐药菌感染的危险因素（OR=1.292、2.112、1.752、1.625，均P<0.05）。结论 高海拔地区COPD患者病原菌以革兰阴性菌为主，而呼吸机及管路污染、机械通气史、频繁更换抗菌药及卧床时间长是COPD患者发生多重耐药菌感染的危险因素。应加强对相关病原菌及危险因素的监测，降低患者感染风险。

The pathogen distribution and related factors in patients with COPD in high altitude area

Abstract: Objective To investigate the distribution of pathogens and related factors in patients with COPD in high altitude areas. Methods A total of 274 patients with COPD admitted to our hospital between January 2016 and January 2019 were enrolled. The pathogens in the sputum were cultured, and the distribution of pathogens and the related factors of multi-drug resistant bacteria(MDRO) infection were analyzed. Results A total of 165 pathogenic bacteria were isolated from the 274 patients (60.2%), among which Gram-negative bacteria accounted for 71.5% (118/165),Gram-positive bacteria accounted for 17.0% (28/165), and fungi accounted for 11.5% (19/165). Univariate analysis showed that MDRO infection in patients with COPD had a certain correlation with age, history of diabetes, bedtime, ventilator pollution, mechanical ventilation history and frequent replacement of antibacterial drugs (all P<0.05). Logistic multivariate analysis showed that ventilator pollution, mechanical ventilation history, frequent replacement of antibacterial drugs and bedtime were the risk factors for MDRO infection in COPD patients (all P<0.05). Conclusion Gram-negative bacteria are the main pathogens in patients with COPD in high altitude areas. Ventilator and pipeline pollution, mechanical ventilation history, frequent replacement of antibacterial drugs and long bedtime are the risk factors for MDRO infection in COPD patients. The monitoring of related pathogens and risk factors should be strengthened to reduce the risk of infection.