老年脑卒中偏瘫患者肺部感染的病原学特点及相关因素

Etiological characteristics and related factors of pulmonaryinfection in senior patients with stroke hemiplegia

目的探讨老年脑卒中偏瘫患者肺部感染的临床病原学特点、危险因素,为临床治疗老年脑卒中偏瘫合并肺部感染患者提供依据。方法选取2013年7月至2014年6月在浙江省宁海县中医医院接受治疗的老年脑卒中偏瘫合并肺部感染患者120例,分析感染患者病原菌分布情况,对造成感染的因素进行单因素和多因素logistic回归分析。结果120例老年脑卒中偏瘫合并肺部感染20例,感染率16.67%;20例感染患者痰培养分离出56株病原菌。其中以革兰阴性菌为主,占53.57%,主要为鲍氏不动杆菌、肺炎克雷白菌;革兰阳性菌居第二,占32.14%,以金黄色葡萄球菌为主;真菌第三,占14.29%,以白色假丝酵母菌为主。对导致老年脑卒中偏瘫患者发生肺部感染的多因素进行分析结果显示,住院时间、机械通气、使用抗菌药物、意识障碍、肾功能不全、侵入性操作为偏瘫患者发生肺部感染的独立危险因素(P<0.05)。结论革兰阴性菌是导致老年脑卒中偏瘫患者发生肺部感染的主要病原菌,住院时间、意识障碍、机械通气、使用抗菌药物、肾功能不全、侵入性操作等是导致患者肺部发生感染的独立危险因素,临床对此应加以重视和予以针对性预防。

Objective To understand the etiological characteristics and related risk factors of pulmonary infection in elderly patients with hemiplegia,and to provide evidence for clinical treatment of hemiplegic patients with pulmonary infection.Methods A total of 120senior patients with hemiplegia treated in our hospital from July 2013to June 2014were enrolled.The distribution of pathogenic bacteria in infected patients was analyzed.Multivariate regression model was used to analyze the related risk factors.Results 20out of 120cases had lung infection with the overall infection rate of 16.67%.A total of 56pathogens were isolated from sputum culture and 53.57%were Gram-negative bacteria with Acinetobacter baumannii and Klebsiella pneumonia predominant,32.14%were Gram-positive bacteria and Staphylococcus aureus was predominant.14.29%were fungi and Candida albicans was predominant.Multivariate logistic regression analysis showed that length of hospital stay,mechanical ventilation,use of antibiotics,disturbance of consciousness,renal dysfunction and invasive procedures were risk factors for pulmonary infection in patients with hemiplegia(P<0.05).Conclusions Gram-negative bacteria are the major pathogens for pulmonary infection in senior patients with hemiplegia.Length of hospital stay,disturbance of consciousness,mechanical ventilation,use of antibiotics,renal dysfunction and invasive procedures are independent risk factors for lung infection of patients.