急性脑卒中相关性肺炎的病原菌分布及危险因素分析

Distribution of pathogens and risk factors of acute stroke-associated pneumonia

目的探讨导致急性脑卒中患者肺部感染的病原菌分布,并同时分析急性脑卒中相关性肺炎的危险因素,以降低其感染率。方法回顾性分析2010年6月1日-2012年6月30日4所医院因急性脑卒中住院的患者,136例脑卒中后并发肺炎患者,根据痰培养结果分析病原菌分布,并采用多因素logistic回归分析急性脑卒中相关性肺炎的危险因素。结果送检合格痰标本201份,共检出病原菌97株,其中革兰阴性杆菌61株占62.89%,革兰阳性菌21株占21.65%,真菌15株占15.46%;其中3例患者同时培养出革兰阴性菌与真菌;多因素logistic相关分析发现病情严重程度、吞咽困难、老年(年龄>60岁)、男性、冠心病、慢性阻塞性肺疾病、糖尿病、脑卒中种类是肺部感染产生的独立危险因素(P<0.05)。结论应依据病原菌分布特点针对性的抗感染用药,并对发生脑卒中相关性肺炎的危险因素采取针对性预防措施。

OBJECTIVE To investigate the distribution of pathogens causing the pulmonary infection of stroke patients and analyze the risk factors of acute stroke-associated pneumonia ,so as to reduce the infection rates . METHODS Retrospective analysis was made on patients who were hospitalized in 4 hospitals due to acute stroke from Jun 1 ,2010 to Jun 30 ,3012 .Among them ,136 patients of acute stroke concurrently suffered from pneumo-nia .The pathogen distribution was analyzed according to sputum culture results .The multiple logistic retrogres-sion analysis was conducted on the risk factors associated with acute stroke-associated pneumonia .RESULTS A total of 201 qualified sputum samples were submitted ,with 97 strains detected containing pathogens ,including 61 strains of gram negative bacteria ,accounting for 62 .89% ,21 strains of gram positive bacteria ,accounting for 21 .65% ,and 15 strains of fungi ,accounting for 15 .46% .Among them ,3 patient samples cultured gram-negative bacteria and fungi at the same time ;the multi-factor logistic correlation analysis showed that the severity ,dyspha-gia ,elderly （age＆gt; 60 years） ,male ,coronary heart disease ,COPD ,diabetes and stroke types were independent risk factors for generating the lung infection （P＆lt;0 .05） .CONCLUSION The anti-infection drugs should be used according to the distribution of bacterial characteristics .At the same time ,preventive measures should be taken to reduce risk factors for acute stroke-associated pneumonia .