急性脑卒中患者肺部感染的病原菌特点及危险因素分析

The study of the characteristics of pathogens and risk factors of lung infections of acute stroke patients

目的探讨急性脑卒中患者肺部感染的病原菌特点及危险因素,以期为控制及降低急性脑卒中患者肺部感染的发生提供参考依据。方法回顾性分析2011年1月-2012年12月208例急性脑卒中患者临床资料,分析肺部感染病原菌特点及危险因素,采取SPSS16.0进行统计分析,计数资料采取χ2检验,多因素分析采取非条件logistic回归分析。结果发生肺部感染的52例肺部感染发生率为25.00%,送检痰液标本培养阳性率为80.77%,检出病原菌共50株,其中革兰阴性菌36株占72.00%,革兰阳性菌12株占24.00%,真菌2株占4.00%,革兰阴性菌主要为肺炎克雷伯菌、鲍氏不动杆菌、铜绿假单胞菌、阴沟肠杆菌,革兰阳性菌主要为金黄色葡萄球菌、表皮葡萄球菌、溶血葡萄球菌;单因素结果分析显示,年龄、糖尿病、侵入性操作、意识障碍、低蛋白血症、住院时间是与肺部感染发生有关的单危险因素(P<0.01),非条件logistic回归分析结果显示,年龄大、有侵入性操作、合并糖尿病、有意识障碍、合并低蛋白血症、住院时间长是发生肺部感染的独立危险因素(P<0.05)。结论急性脑卒中患者容易发生肺部感染,感染病原菌以革兰阴性菌为主,患者年龄大、有侵入性操作、合并糖尿病、有意识障碍、合并低蛋白血症、住院时间长是引起患者发生肺部感染的独立危险因素。

OBJECTIVE To investigate the pathogen characteristics and risk factors of acute stroke patients with pulmonary infections, in order to control and reduce the lung infections in patients with acute stroke. METHODS Retrospective analysis of clinical data of 208 cases of acute cerebral apoplexy patients were carried out, the patients suffered from hospital pulmonary infections were selected as infection group and the others were selected as control group. Pathogen characteristics and risk factors were analysed. RESULTS The incidence of pulmonary infection was 25.00%, sputum specimen culture positive rate was 80.77 %, 50 bacteria strains were detected, including 36 strains of gram-negative bacteria, accounting for 72. 00%, 12 strains gram-positive bacteria, accounting for 24.00% and 2 fungi,accounting for 4.00%, gram negative bacteria mainly were Klebsiella pneumoniae, Acineto-bacter baumannii, Pseudomonas aeruginosa, Sewer intestinal bacilli, gram positive bacteria mainly were Staphy-lococcus aureus , Staphylococcus epidermidis , Staphylococcus haemolyticus. Single factor analysis showed that age, diabetes, invasive operation, disturbance of consciousness, hypoalbuminemia, the length of time were related to pulmonary infection （P〈0.01）. Unconditioned logistic regression analysis showed that age, invasive operation, merger diabetes, conscious disorder, hypoalbuminemia, long hospital stay was the independent risk factors of pulmonary infection in patients with acute stroke （P〈0.05）. CONCLUSION Acute cerebral apoplexy patients were prone to infected by gram-negative bacteria. Patients＇ age, invasive operation, merger diabetes, conscious disorder, hypoalbuminemia, long hospital stay were independent risk factors of pulmonary infections in patients with acute stroke.