脑血管疾病合并肺部感染的病原学分析及抗生素治疗体会

Analysis of the pathogenic organism and the results of antibiotic treatment of pneumonia in patients with cerebral vascular disease

目的:对脑血管疾病合并肺部感染的病因及病原学进行分析,初步探讨抗生素的合理应用。方法:对2003年1月-2006年11月收住我院的84例脑血管疾病合并肺部感染的患者进行病因学分析,根据呼吸道分泌物培养及药敏试验结果,分析抗生素治疗的效果及疾病转归。结果:脑血管疾病合并肺部感染患者假性球麻痹、意识障碍、低蛋白血症、慢性阻塞性肺部疾病、糖尿病、心脏疾病的发生率均>30%。病原学分析提示居前3位的病原菌为肺炎克雷伯菌(47株,占27·3%)、铜绿假单胞菌(31株,占18·0%)和金黄色葡萄球菌(21株,占12·2%)。其中金黄色葡萄球菌全部对万古霉素敏感,肺炎克雷伯菌、铜绿假单胞菌对亚胺培南、阿米卡星、头孢哌酮+舒巴坦、头孢他啶、环丙沙星等比较敏感,其中肺炎克雷伯菌对亚胺培南、阿米卡星、头孢哌酮+舒巴坦敏感性相对较高,铜绿假单胞菌对亚胺培南、环丙沙星、阿米卡星敏感性相对较高。结论:脑血管疾病合并肺部感染患者多合并高血压、慢性阻塞性肺疾病、糖尿病、心脏病,或出现假性球麻痹、意识障碍、营养状况不佳。脑血管疾病合并肺部感染的主要病原菌为G-杆菌,碳青霉烯类如亚胺培南、氨基糖甙类如阿米卡星、第三代头孢菌素头孢哌酮+舒巴坦、头孢他啶,奎诺酮类如环丙沙星在治疗脑血管病合并肺部感染时可作为经验性优先选用药物。

Objective：To study the pathogenesis and the pathogenic organisms of pneumonia in patients with cerebral vascular diseases, and to evaluate the rational use of antibiotics in clinical practice. Methods： Retrospective analysis was performed in 84 cases of pneumonia in patients with cerebral vascular diseases in the Department of Neurology in our hospital. Excretion from respiratory tract was cultivated followed by antibiotic sensitivity test, and the results of antibiotic treatment and the outcome of the patients were analyzed. Results： A high incidence（〉 30 % ） of pulmonary infection was observed in patients with cerebral vascular disease accompanied by hypertension, or chronic obstructive pulmonary disease, diabetes mellitus, heart disease, pseudobulbar paralysis, disorders of mentation, or malnutrition. The data revealed that Klebsiella of 47 species （27. 3%） ranked first among isolated bacteria, Pseudomonas aeruginosa of 31 species （ 18.0 % ） was the next, and followed by Staphylococcus aureus of 21 species（ 12.2% ）. All Staphylococcus aureus species were sensitive to Vancomycin,while Klebsiella and Pseudomonas aeruginosa were sensitive to lmipenem, Amikacin, Cefoperazone Sodiun plus Sulbactam Sodiun, Ceftazidime, and Ciprofloxacin. Conclusion：Patients with cerebral vascular disease are susceptible to pulmonary infection when there is chronic obstructive pulmonary disease, pseudobulbar paralysis, disorders of mentation, or malnutrition. The main pathogenic organisms are Gram-negative bacilli. Antibiotics including Imipenem, Amikacin, Cefoperazone Sodiun plus Sulbactam Sodiun, Ceftazidime, and Ciprofloxacin can be empirically used in the treatment of cerebral vascular diseases patients with pneumonia.