急性脑卒中并发肺部感染的病原菌及相关危险因素的调查
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摘要
目的对急性脑卒中并发肺部感染的病原菌谱及相关危险因素进行分析,为急性脑卒中的临床治疗提供科学依据。方法回顾性分析2011年1月~2013年12月在徐州市中心医院住院治疗的急性脑卒中并发肺部感染患者的病原菌谱和相关危险因素。结果 318例急性脑卒中患者合并肺部感染97例,感染率为30.5%。97例急性脑卒中患者合并肺部感染患者共分离病原菌116株,有16例出现了双重感染,有3例出现了3重感染,检出真菌23株,占19.83%,革兰氏阳性菌34株,占29.31%,革兰氏阴性菌59株,占50.86%。急性脑卒中并发肺部感染与患者年龄、发病时间、住院时间、脑卒中史、慢性肺病、意识障碍、卒中类型、糖尿病、长期吸烟、低蛋白血症、肾功能不全、卧床时间、侵入性操作、免疫疾病等因素密切相关(P<0.01),而与性别、吞咽困难、高血压、高血脂、心力衰竭、合并冠心病无密切相关性(P>0.05)。结论医院急性脑卒中并发肺部感染受多种因素的影响,病原菌谱已经由革兰氏阳性菌多见转为革兰氏阴性菌多见,要预防急性脑卒中并发肺部感染必须采取多种综合干预措施。
Objective To analyze pathogen spectrum and the related risk factors of acute cerebral stroke complicated with pulmonary infection and provide scientific basis for the clinical treatment of acute stroke. Methods The 318 patients with apoplexy patients complicated with pulmonary infection in Xuzhou Municipal Central Hospital from January 2011 to December 2013 were retrospective analyzed. Results The 97 of 318 acute stroke patients with pulmonary infection(30.5%)were reported. 116 strains of pathogenic bacteria were isolated from 97 patients with acute cerebral stroke complicated with pulmonary infection. 16 cases of double infection and 3 cases of triple infection were found. 23 strains of fungi were detected(19.83%), 34 strains of gram positive bacteria(29.31%), 59 isolates of gram negative bacilli(50.86%).There was close correlaton of the acute cerebral stroke complicated with pulmonary infection with age, time of onset, duration of hospitalization, history of stroke, chronic lung disease, disorder of consciousness, the type of stroke, diabetes, smoking, hypoalbuminemia, renal insufficiency, time in bed, invasive operation, immune diseases(P<0.01), no close correlation with sex, dysphagia,hypertension, hyperlipidemia, coronary heart disease and heart failure was noticed.(P > 0.05). Conclusion Acute cerebral stroke complicated with pulmonary infection in hosptialized patients was influenced by many factors, the prodominant bacterium was gram negative bacteria, and comprehensive intervention measures be adopted.
Objective To analyze pathogen spectrum and the related risk factors of acute cerebral stroke complicated with pulmonary infection and provide scientific basis for the clinical treatment of acute stroke. Methods The 318 patients with apoplexy patients complicated with pulmonary infection in Xuzhou Municipal Central Hospital from January 2011 to December 2013 were retrospective analyzed. Results The 97 of 318 acute stroke patients with pulmonary infection(30.5%)were reported. 116 strains of pathogenic bacteria were isolated from 97 patients with acute cerebral stroke complicated with pulmonary infection. 16 cases of double infection and 3 cases of triple infection were found. 23 strains of fungi were detected(19.83%), 34 strains of gram positive bacteria(29.31%), 59 isolates of gram negative bacilli(50.86%).There was close correlaton of the acute cerebral stroke complicated with pulmonary infection with age, time of onset, duration of hospitalization, history of stroke, chronic lung disease, disorder of consciousness, the type of stroke, diabetes, smoking, hypoalbuminemia, renal insufficiency, time in bed, invasive operation, immune diseases(P<0.01), no close correlation with sex, dysphagia,hypertension, hyperlipidemia, coronary heart disease and heart failure was noticed.(P > 0.05). Conclusion Acute cerebral stroke complicated with pulmonary infection in hosptialized patients was influenced by many factors, the prodominant bacterium was gram negative bacteria, and comprehensive intervention measures be adopted.
引文
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[2]陈多.脑卒并发肺部感染的护理体会[J].临床和实验医学杂志,2006,5(12):1930.
[3]陈金梅,周维智,刘晓红,等.老年急性脑卒中6个月预后及其影响因素[J].中华实用诊断与治疗杂志,2011,25(6):557-559.
[4]王子玲,刘新,李慧娟.肺结核合并院内肺部细菌感染的临床特征[J].临床肺科杂志,2011,16(8):1274-1275.
[5]费晓云,胡必杰,陈雪华,等.呼吸机相关性肺炎初始抗菌药物选择与预后的相关性研究[J].中华医院感染学杂志,2011,21(12):2573-2575.
[6]刘向欣,耿贺梅,张淑青.重症监护病房呼吸机相关性肺炎病原菌分布及耐药性分析[J].中华医院感染学杂志,2011,21(13):2839-2841.
[7]王晋舜.肺结核合并肺部感染270例病原学分类及分析[J].中国误诊学杂志,2011,11(24):5924-5925.
[8]黄小燕.脑卒中重症监护室患者肺部感染原因分析与护理对策[J].中国医药指南,2011,9(36):459-460.
[9]中华医学会结核病学分会.肺结核诊断和治疗指南[J].中华结核和呼吸杂志,2001,24(2):70-74.
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