脑卒中患者肺部感染临床特征分析

Clinical characteristics of stroke patients complicated with pulmonary infections

目的探讨脑卒中患者肺部感染临床特征及防治措施,为临床诊治提供参考。方法于2008年1月-2012年3月对360例脑卒中患者的临床资料进行回顾性分析,观察肺部感染发生率、痰培养结果、相关因素及对预后影响,采用SPSS13.0软件进行统计分析,计量资料采用t检验,计数资料采用χ2检验。结果 360例脑卒中患者发生肺部感染80例,发生率22.22%;痰培养共分离病原菌60株,其中革兰阴性杆菌32株占53.33%、革兰阳性球菌16株占26.67%,真菌12株占20.00%,排前5位病原菌依次为白色假丝酵母菌、铜绿假单胞菌、金黄色葡萄球菌、大肠埃希菌、表皮葡萄球菌,分别占20.00%、15.00%、13.33%、10.00%、10.00%;患者年龄(61.80±18.89)岁、脱水剂应用(14.12±3.40)d、昏迷、侵入性操作、应用制酸剂、预防应用抗菌药物是发生肺部感染相关因素(P<0.05)。结论脑卒中患者发生肺部感染率高,可延长住院时间、增加病死率,需针对脑卒中患者的生理特点及病理生理改变,采取积极措施减少肺部感染的发生。

OBJECTIVE To explore the clinical characteristics of the stroke patients complicated with pulmonary infections and put forward prevention and treatment measures so as to provide guidance for the clinical diagnosis and treatment. METHODS The clinical data of 360 cases of stroke patients who were treated in the hospital from Jan 2008 to Mar 2012 were retrospectively analyzed, then the incidence of pulmonary infections and the result of sputum culture were observed, the related factors were analyzed, and the effect on prognosis was evaluated; the statistical analysis was performed with the use of SPSS13.0 software, t-test was carried out for the measurement variables, and chi-square test was performed for the count data. RESULTS Of totally 360 cases of stroke patients, the hospital-acquired pneumonia occurred in 80 cases with the incidence rate of 22.22%. Of totally 60 strains of pathogens isolated from sputum culture of the 80 patients, there were 32 （53. 33%） strains of gram-negative bacilli, 16（26. 67%） strains of gram-positive cocci, and 12（20. 00%） strains of fungi; the Candida albicans （20.00 % ）, Pseudomonas aeruginosa （ 15. 00 % ）, Staphylococcus aureus （ 13. 33% ）, Escherichia coli（ 10. 00 % ）, and Staphylococcus epidermidis（lO. 00%） ranked the top 5 specie of pathogens. The （61.80 ±18.89）years of age, use of dehydrating agent for （14.12±3.40） days, coma, invasive operation, use of antacids, and prophylactic use of antibiotics were the related factors for pulmonary infections （P〈0.05）. CONCLUSION The incidence of pulmonary infections is high in the stroke patients, which may result in the extension of length of hospitalization and the increase of mortality, and it is necessary to take active measures in accordance with the pathophysiological change.