急性脑卒中患者并发医院感染的临床特点及危险因素分析

Clinical features and risk factors of nosocomial infection in patients with acute stroke

目的探讨急性脑卒中患者医院感染的临床特点,分析医院感染的危险因素。方法回顾性分析2010年6月至2011年12月住院的387例急性脑卒中患者的临床资料。筛选出发生医院感染的患者,统计医院感染发生率、分析感染部、病原菌及影响因素。结果 387例急性脑卒中患者中发生医院感染63例,感染率16.28%,感染部位以下呼吸道最多,病原菌以G-菌为主。单因素分析显示,年龄≥65岁、意识障碍、球麻痹、侵入性操作、机械通气、糖尿病、肌力3级或3级以下、预防性应用抗生素及住院时间长是急性脑卒中患者医院感染率增高的影响因素(P<0.05或P<0.01)。多因素分析显示,意识障碍、球麻痹、机械通气、肌力3级或3级以下、预防性应用抗生素及住院时间长是其发生医院感染的独立危险因素(P<0.05或P<0.01)。结论急性脑卒中患者的医院感染发生率高,应加强脑血管病的一级和二级预防,减少卒中风险,积极治疗原发病,控制相关危险因素,从而减少医院感染的发生。

Objective To explore the chnical features and risk factors of nosocomial infection in patients with acute stroke. Methods From June 2010 to December 2011 , the clinical data of 387 patients with acute stroke were analyzed retrospectively, in which nosocomial infection patients were collected. The incidence and site of infection, pathogens and possible influencing factors were analyzed. Results Sixty-three nosocomial infection cases were found among these patients, and the incidence rate was 16.28%. The most common infection site was lower respiratory tract, and G- bacteria was the main pathogenic bacteria. The univariate analysis showed that patients aged more than or equal to 65 years, disorder of consciousness, bulbar paralysis, invasive procedure, mechanical ventilation, diabetes, myodynamia at grades 3 or less than 3, prophylactic antibiotics use, long hospitalization stay were influencing factors of higher nosocomial infection rate （P 〈 0.05 or P 〈 0.01 ）. The multiple variable logistic regression analysis showed that the independent risk factors of nosocomial infection were disorder of consciousness, bulbar paralysis, mechanical ventilation, myodynamia at grades 3 or less than 3, prophylactic antibiotics use and long hospitalization stay（P 〈 0.05 or P 〈 0.01 ）. Conclusions The nosocomial infection rate is high in the patients with acute stroke. It should be emphasized that strengthening primary and secondary prevention on of cerebrovascular disease, reducing risk of stroke, treating the primary disease actively and controlling the related risk factors may be necessary to reduce nosocomial infection.