摘要
背景老年人群身体机能降低,肺部感染后更易出现胃食管反流(gastroesophageal reflux,GER),会诱发气道炎症,加重感染程度,甚至危及患者生命安全.因此,本研究尝试探索老年肺部感染继发胃食管反流的风险因素,以期提前预测风险、改善患者预后.目的观察老年肺部感染合并GER的临床特征,并分析其影响因素.方法选取2021-01/2024-08就诊于义乌中西医结合医院的159例老年肺部感染患者为研究对象,观察老年肺部感染合并GER患者的临床特征,并统计发生率,依据是否合并GER分为研究组、对照组,对比两组临床资料,采用Logistic回归分析老年肺部感染合并GER的影响因素.结果159例老年肺部感染中有63例(39.62%)细菌感染,51例(32.08%)病毒感染,31例(19.50%)支原体感染,另有14例(8.81%)为混合感染.159例老年肺部感染患者中,GER发生率39.62%(63/159).老年肺部感染合并GER患者均存在呼吸急促、发热及双肺干湿啰音,多数患者出现剧烈咳嗽(90.48%)、反酸(95.24%)、烧心(93.65%)症状,同时白细胞计数升高患者占比96.83%,C反应蛋白升高占比95.24%;影像学检查提示,病变以中下肺野区为主,可见双肺多发斑片影(61.90%)、单侧肺不张(41.27%).两组年龄、睡眠障碍、肺部感染严重程度、焦虑情绪、服用镇静药、机械通气、糖尿病病史、既往GER疾病史方面对比,差异有统计学意义(P<0.05).Logistic回归分析显示,肺部感染严重程度、年龄、焦虑情绪、肺部感染严重程度、既往GER疾病史、糖尿病病史是老年肺部感染患者合并GER的独立影响因素(P<0.05).结论老年肺部感染合并GER患者临床症状及体征具有一定特异性,患者合并GER的独立危险因素包括肺部感染严重程度、焦虑情绪、年龄、既往GER疾病史、睡眠障碍、糖尿病病史,临床工作者可加强对高危患者的针对性干预以减少GER的发生.
BACKGROUND Since elderly people have declined physical function,and gastroesophageal reflux(GER)is more likely to occur after lung infection in this population,which will induce airway inflammation,aggravate the degree of infection,and even endanger the life of patients.Therefore,this study attempts to explore the risk factors for GER secondary to lung infection in the elderly,in order to predict the risk in advance and improve the prognosis of patients.AIM To observe the clinical characteristics of elderly patients with pulmonary infection complicated by GER disease,and analyze their influencing factors.METHODS A total of 159 elderly patients with pulmonary infection who visited Yiwu Integrated Traditional Chinese and Western Medicine Hospital from January 2021 to August 2024 were selected as the study subjects.The clinical characteristics of elderly patients with pulmonary infection complicated by GER were observed,and the incidence rate of GER was calculated.Patients were categorized into a study group and a control group based on whether they had GER.The clinical data of the two groups were compared,and Logistic regression analysis was used to analyze the influencing factors of pulmonary infection complicated by GER in the elderly.RESULTS Among 159 elderly patients with pulmonary infections,63(39.62%)had bacterial infections,51(32.08%)had viral infections,31(19.50%)had mycoplasmal infections,and 14(8.81%)had mixed infections.The incidence of GER was 39.62%(63/159).Elderly patients with pulmonary infections complicated by GER all presented with shortness of breath,fever,and bilateral lung rales,with most patients experiencing severe cough(90.48%),acid reflux(95.24%),and heartburn(93.65%).At the same time,96.83%of patients had elevated white blood cell count,and 95.24%had elevated C-reactive protein.Imaging studies indicated that the lesions were located mainly in the middle and lower lung fields,with multiple patchy shadows(61.90%)and unilateral atelectasis(41.27%)visible in both lungs.There were significant differences in age,sleep disorders,severity of pulmonary infection,anxiety,use of sedatives,mechanical ventilation,history of diabetes,and previous history of GER disease between the two groups(P<0.05).Logistic regression analysis showed that the severity of pulmonary infection,age,anxiety,previous history of GER disease,and history of diabetes were independent influencing factors for GER in elderly patients with pulmonary infection(P<0.05).CONCLUSION The clinical symptoms and signs of elderly patients with pulmonary infection combined with GER exhibit certain specificity.The independent risk factors for GER in patients with pulmonary infection include the severity of pulmonary infection,anxiety,age,previous history of GER disease,sleep disorders,and diabetes history.Clinicians should strengthen targeted intervention for high-risk patients to reduce the incidence of GER.
作者
黄智一
Zhi-Yi Huang(Department of General Medicine,Yiwu Hybrid Chinese-Western Medicine Hospital,Yiwu 32200,Zhejiang Province,China)
出处
《世界华人消化杂志》
2025年第8期640-648,共9页
World Chinese Journal of Digestology
关键词
肺部感染
胃食管反流
临床特征
风险因素
焦虑情绪
Pulmonary infection
Gastroesophageal reflux disease
Clinical characteristics
Risk factors
Anxiety
作者简介
通讯作者:黄智一,主治医生,研究方向为内科学,本科,322000,义乌市江滨西路375号,义乌中西医结合医院全科.hehao253491@163.com。
