急性脑梗死合并肺部感染的危险因素分析及防治

Risk factor analysis and prevention of acute cerebral infarction complicated with pulmonary infection

目的探讨急性脑梗死合并肺部感染的相关危险因素以及防治措施,为该病的治疗提供参考依据。方法回顾性分析2010年5月～2012年4月本院收治的90例急性脑梗死患者,分为肺部感染组28例和对照组62例,分析相关危险因素及防治措施。结果与对照组比较,肺部感染组合并吞咽困难、意识障碍以及大面积脑梗死、肺部疾病等基础疾病明显增多;肺部感染组NIHSS、临床神经功能缺损评分较对照组明显升高;肺部感染组血清的pH、氧分压(PaO2)、CO2分压(PaCO2)、全血高切黏度均与对照组差异显著,且血清肿瘤坏死因子-α和白细胞介素-6明显高于对照组。结论 COPD病史、入院时NIHSS评分高、吞咽困难、意识障碍、大面积脑梗死以及基础疾病是急性脑梗死合并肺部感染的危险因素,一旦诊断,应当给予积极有效的治疗,包括保持呼吸道通畅,及时改善肺功能,纠正脑缺氧,降低脑梗死面积,协助患者经常改变体位,合理选用抗生素,加强营养支持等。

Objective To study the associated risk factors and prevention of acute cerebral infarction complicated with pulmonary infection, so as to provide the references for treatment. Methods Ninety patients with acute cerebral infarction complicated with pulmonary infection from 2010 May to 2012 April in our hospital were divided into pulmonary infection group （ n = 28） and control group （n = 62）. The associated risk factors and prevention were analyzed. Results Com- pared with the control group, the dysphagia, disturbance of consciousness, large area cerebral in- farction, and pulmonary disease increased significantly in pulmonary infection group. The NIHSS score, neural function defect score of pulmonary infection group were significantly higher than that in the control group. The serum pH, PaO2, PaCO2, whole blood viscosity in the two groups had significant difference, and the serum TNF-a and IL-6 of pulmonary infection group were markedly higher than that in the control group. Conclusion The history of COPD, high NIHSS score, dys- phagia, disturbance of consciousness, large area cerebral infarction as well as the basic disease are the risk factors of acute cerebral infarction complicated with pulmonary infection. The patients should be given positive effective treatment to maintain respiratory tract unobstructed, improve lung function timely, correct the brain hypoxia, decrease infarction area, assist the patient to change pos- tures selected antibiotics reasonably, and strengthen nutritional support.