急性脑卒中并发肺部感染的致病菌及相关危险因素的分析

The pathogen of acute cerebral stroke complicated with pulmonary infection and investigation on related risk factors

目的对急性脑卒中并发肺部感染的病原菌谱及相关危险因素进行统计分析,寻求预防急性脑卒中患者并发肺部感染的科学方法。方法收集统计2010年5月至2014年5月在我院住院治疗的298例急性脑卒中患者并发肺部感染患者的病原菌谱的检出情况,回顾性分析相关危险因素。结果 298例急性脑卒中患者合并肺部感染93例,感染率为31.20%,共分离病原菌108株,其中真菌21株,占19.44%,革兰氏阳性菌32株,占29.63%,革兰氏阴性菌55株,占50.93%;以铜绿假单胞菌、金黄色葡萄球菌、白色假丝酵母菌较为常见。急性脑卒中并发肺部感染与患者年龄、发病时间、住院时间、脑卒中史、慢性肺病、意识障碍、卒中类型、糖尿病、长期吸烟、低蛋白血症、肾功能不全、卧床时间、侵入性操作、免疫疾病等因素密切相关(P<0.01),而与性别、吞咽困难、高血压、高血脂、心力衰竭、合并冠心病无密切相关性(P>0.05)。结论医院急性脑卒中并发肺部感染受多种因素的影响,病原菌谱为革兰氏阴性菌多见,要预防急性脑卒中并发肺部感染必须采取多种综合干预措施。

Objective To analyze the pathogen spectrum of acute cerebral stroke complicated with pulmonary infection and the related risk factors, and provide scientific basis for the clinical treatment of acute stroke. Methods Retrospective analysis of the pathogen spectrum of 298 cases of acute cerebral stroke complicated with pulmonary infection and related risk factors from 2010 January to 2013 December. Results In 298 cases of acute cerebral apoplexy patients,93 cases were complicated with pulmonary infection,with an infection rate of 31.20%.108 strains of pathogenic microbes were isolated, including 21 strains of fungi,accounted for 19.44%,32 strains of gram positive bacteria,accounted for 29.63%,55 cases of gram negative bacteria,accounted for 50.93%. Pseudomonas aeruginosa, Staphylococcus aureus and Candida yeast were the common pathogens. Acute cerebral stroke complicated with pulmonary infection in patients was significantly correlated with age,time of onset,duration of hospitalization,history of stroke,chronic lung disease,disorder of consciousness, the type of stroke, diabetes, smoking, hypoalbuminemia, renal insufficiency, in bed time, invasive operation, and immune diseases（P〈0.05）, but showed no significant correlation with gender, dysphagia, hypertension,hyperlipidemia, and coronary heart disease with heart failure（P 〉0.05）. Conclusion Hospital acute cerebral stroke complicated with pulmonary infection is influenced by many factors. The Gram negative bacteria were the common pathogenic bacteria. To the prevention of acute cerebral stroke complicated with pulmonary infection must adopt a variety of comprehensive intervention measures.