早发性卒中相关性肺炎危险因素与病原学特点的研究

Research of pathogen features and risk factors of early-onset stroke-associated pneumonia

目的研究早发性卒中相关性肺炎（EOP）危险因素及细菌谱特点。方法回顾分析2008年1月至2010年12月54例EOP患者及同期50例无EOP的急性脑卒中患者的资料。结果两组患者吸烟史、糖尿病史、肺部基础病变、呕吐误吸、卒中部位、卒中范围大小、NIHSS评分、意识障碍、吞咽困难、留置鼻饲管、使用药物（如脱水镇静药物、糖皮质激素等）、颅脑手术治疗、气管切开／插管等侵入性操作、营养不良差异有统计学意义（尸〈0．05），两组体位差异无统计学意义俨〉0．05）。细菌谱检查发现铜绿假单胞菌8例，大肠埃希氏菌5例，肺炎克雷伯菌7例，鲍曼不动杆菌3例，金黄色葡萄球菌4例，奇异变形菌8例，阴沟肠杆菌6例，无乳链球菌（B群）2例，白色念珠菌3例，热带念珠菌2例，屎肠球菌2例，α链球菌2例，奈瑟氏菌2例。结论大多数EOP的病原体是社区获得性病菌，少部分是潜在多重耐药性的医院内获得性病原菌。机体抵抗力减弱、消化道及呼吸道细菌定植、不当操作导致的误吸是EOP的危险因素。加强支持治疗及呼吸道管理，减少细菌异位、合理使用抗生素或可减少EOP的发生。

Objective To research the risk factors and bacterial spectrum of early-onset stroke-associated pneumonia （EOP）. Method Retrospectively analysis was conducted to study the clinical material of 54 patients with EOP and 50 patients with non-EOP stroke from Jan 2008 to Dec 2010. Results There were significant differences of smoke, diabetes, pulmonary disease, dystrophy, vomit, aspiration, stroke position and range, National Institute of Health Stroke Scale （NIHSS）, consciousness disorder, dysphasia, nasogastric feeding, trachea cannula, tracheotomy and craniotomy between the group of EOP and control group （P〈O.O1）. There were no significant differences of medicine and position of patients （P〉O.OS）.There were 8 cases infected with pseudomonas aeruginosa, 5 cases with escherichia coli, 7 cases with klebsiella pneumonia, 3 cases with acinetobacter baunlannii, 4 cases with staphylococcus aureus, 8 cases with proteus mirabilis, 6 cases with enterobacter cloacae, 2 cases with streptococcus agalactia, 3 cases with albicans saccharomyces, 2 cases with Candida tropicalis, 2 cases with enterococcus faecium, 2 cases with streptococcus A, 2 cases with Neisseria. Conclusion The pathogen of EOP is community acquired pathogens or hospital acquired pneumonia pathogen with potential drug resistance. The critical factors are weakening of resistance power, planting of bacterium and aspiration. The correct measures should include nutritional support, respiratory management, reduce of bacterial dystopy and reasonable use of antibiotic.