老年脑卒中患者肺部感染的临床分析

Risk factors for pulmonary infections in elderly patients with stoke

目的探讨老年脑卒中患者肺部感染的临床特征及危险因素,为临床治疗提供依据。方法调查2013年1月-2014年2月344例老年脑卒中住院患者临床资料,感染病原菌采用法国生物梅里埃公司自动细菌鉴定仪进行检测,并分析影响感染的相关因素,数据采用SPSS 13.0统计软件进行处理。结果 344例老年脑卒中住院患者中发生肺部感染79例,感染率为22.97%;共分离出104株病原菌,革兰阴性菌64株占61.54%,革兰阳性菌40株占38.46%,其中以肺炎克雷伯菌、金黄色葡萄球菌居多,分别占37.50%、25.96%;患有呼吸系统疾病及糖尿病、年龄≥60岁、住院时间>4周、多种抗菌药物联合使用、侵入性诊疗、低蛋白血症等均是脑卒中患者发生肺部感染的危险因素。结论肺部感染在老年脑卒中住院患者中发生率较高,病原菌分布复杂且影响危险因素多,临床控制危险因素的同时选择针对性抗菌药物控制感染。

OBJECTIVE To explore the clinical characteristics the elderly patients with stroke complicated with pulmonary infections so as to provide guidance for clinical treatment .METHODS The clinical data of 344 elderly patients with stroke who were hospitalized from Jan 2013 to Feb 2014 were investigated ,then the pathogens causing infections were identified by using automatic bacteria identification system of BioMérieux ,France ;the risk factors for the infections were analyzed ,and the statistical analysis of data was performed with the use of SPSS 13 .0 software .RESULTS Of the 344 elderly patients with stroke who were hospitalized ,the pulmonary infections occurred in 79 cases with the infection rate of 22 .97% .A total of 104 strains of pathogens have been isolated , including 64 （61 .54% ） strains of gram-negative bacteria and 40 （38 .46% ） strains of gram-positive bacteria ;the Klebsiella pneumoniae and Staphylococcus aureus were the predominant species of pathogens ,accounting for 37 .05% and 25 .96% ,respectively .The risk factors for the pulmonary infections in the patients with stoke included the complication of respiratory diseases or diabetes ,no less than 60 years of age ,length of hospital stay more than 4 weeks , combination use of multiple antibiotics , invasive procedures , and hypoproteinemia . CONCLUSIONS The incidence of pulmonary infections is high among the elderly hospitalized patients with stoke , the distribution of the pathogens is complex ,and there are a variety of risk factors .It is necessary to control the risk factors and use targeted antibiotics so as to control the infections .