脑卒中患者医院内获得性肺炎危险因素分析

Risk factors of nosocomial acquired pneumonia in the patients with apoplexy

目的探讨脑卒中患者医院内获得性肺炎的危险因素厦防治措施。方法对我院2003—01—01-2004—12—31 1832例脑卒中住院患者进行调查统计分析。结果医院内获得性肺炎感染率为5．57％，其中脑出血、脑梗死患者感染率分剐为7．72％（24／311）和5．13％（78／1521）。Logistic多因素分析提示，发生医院内获得性肺炎OR的大小依次是预防应用抗生素、气管插管、气管切开、昏迷、应用H2受体阻滞刑、糖尿病、住院天数、吞咽困难、慢性阻塞性肺病（COPD）、鼻饲胃管。结论住院天数、气管切开、气管插管、鼻饲胃管、糖尿病、COPD、昏迷、吞咽困难、应用H2受体阻滞荆和预防应用抗生素等10个因素为脑卒中患者医院内获得性肺炎的相关危险因素。提示在临床工作中应予重视并加强防护，减少医院内获得性肺炎的发生。

Objective To explore the risk factors and preventive measures for nosocomial acquired pneumonia in the patients with apoplexy. Method A prospective and retrospective study was carried out to investigate the clinical data of 1832 patients with apoplexy during January 1st, 2003 to December 31st, 2004. Results The nosocomial acquired pneumonia rate was 5.57%. The nosocomial acquired pneumonia rate in the patients with cerebral hemorrhage and cerebral infarction was 7.72 %（24/311）and 5.13% （78/1521） respectively. The risk factors were the application of antibiotics,tracheal intubation, tracheotomy, confusion,H2 - receptor blocking agents, duration of diabetes mellitus, the days of hospitaization, dysphagia, chronic obstructive pulmonary disease（COPD） and enteral nutrition infusion. Conclusions Nosocomial acquired pneumonia is closely related to ten factors： the days of hospitalization, tracheal intubation, tracheotomy , confusion, enteral nutrition infusion, duration of diabetes mellitus, dysphagia, COPD and the application of antibiotics and H2- receptor blocking agents. The results suggest that we should pay attention to clinical treatment and nursing in order to lower the occurrence of the nosocomial acquired pneumonia.