老年下呼吸道感染的病原学特征及经鼻高流量湿化氧疗辅助的疗效分析

Etiological characteristics of lower respiratory tract infection in the elderly and efficacy of humidified high-flow nasal cannula oxygen therapy

摘要:

目的 探讨老年下呼吸道感染的病原学特征及经鼻高流量湿化氧疗（HFNC）辅助治疗效果。方法 选取2019年1月—2023年1月承德医学院附属医院收治的98例老年下呼吸道感染患者，均采集痰标本行菌株鉴定，并以随机数字表法分为研究组和对照组，每组49例。对照组给予传统经鼻导管或面罩吸氧，研究组给予HFNC，治疗1周后观察疗效。统计老年下呼吸道感染患者感染病原菌分布情况，对比两组临床症状改善情况、临床疗效、肺功能、气道重塑情况、炎症因子及并发症情况。结果 98例老年下呼吸道感染患者中，共检出152株病原菌，其中革兰阴性菌99株，以肺炎克雷伯菌为主；革兰阳性菌43株，以金黄色葡萄球菌为主；真菌10株，以假丝酵母菌为主。研究组呼吸困难消失时间、咳嗽症状消失时间、肺部湿啰音消失时间短于对照组（P <0.05）。研究组总有效率高于对照组（P <0.05）。研究组治疗前后用力肺活量、第1秒用力呼气容积（FEV₁）/FVC、呼吸频率、人软骨糖蛋白-39、结缔组织生长因子、转化生长因子-β₁、白细胞介素-6、白细胞介素-1、单核细胞趋化蛋白-1的差值均高于对照组（P <0.05）。两组总并发症发生率比较，差异无统计学意义（P >0.05）。结论 老年下呼吸道感染患者中多见革兰阴性菌和革兰阳性菌感染，HFNC辅助治疗可提高疗效，改善肺功能及气道重塑，抑制炎症反应，安全可靠。

Abstract:

Objective To investigate the etiological characteristics of lower respiratory tract infection in the elderly and efficacy of humidified high-flow nasal cannula (HFNC) oxygen therapy.Methods A total of 98 elderly patients with lower respiratory tract infection admitted to our hospital from January 2019 to January 2023 were selected. Sputum samples were collected for strain identification, and the patients were divided into the study group and the control group by the random number table method, with 49 cases in each group. The control group was given conventional oxygen therapy via nasal cannulas or face masks, while the study group was given humidified HFNC oxygen therapy. The therapeutic efficacy was observed after 1 week of treatment. The distribution of pathogens in elderly patients with lower respiratory tract infection was analyzed. The improvement of clinical symptoms, clinical efficacy, lung function, airway remodeling, levels of inflammatory factors and incidence of complications were compared between the two groups.Results In 98 elderly patients with lower respiratory tract infection, 152 strains of pathogens were detected, including 99 strains of Gram-negative bacteria (mainly Klebsiella pneumoniae), 43 strains of Gram-positive bacteria (mainly Staphylococcus aureus), and 10 strains of fungi (mainly Candida). The time to dyspnea, cough and moist rales disappearance in the study group was shorter than that in the control group (P < 0.05). The overall effective rate of the study group was higher than that of the control group (P < 0.05). The differences of the forced vital capacity (FVC), forced expiratory volume in one second (FEV₁) / FVC, respiratory frequency, and levels of human cartilage glycoprotein-39, connective tissue growth factor, transforming growth factor-β₁, interleukin-6, interleukin-1, and monocyte chemotactic protein-1 before and after treatment in the study group were higher than those in the control group (P < 0.05). There was no significant difference in the overall incidence of complications between the two groups (P > 0.05).Conclusions Elderly patients with lower respiratory tract infection are more frequently infected with Gram-negative bacteria and Gram-positive bacteria. The humidified HFNC oxygen therapy enhances clinical efficacy, improves lung function and airway remodeling, and inhibits inflammatory responses, being safe and reliable.