脑梗死患者肺部感染危险因素与病原菌分析

Risk factors for pulmonary infections in cerebral infarction patients and analysis of pathogens

目的探讨脑梗死长期卧床患者肺部感染危险因素及病原菌分布特点,为降低患者肺部感染提供参考。方法回顾性分析2011年9月-2014年9月医院收治的300例脑梗死患者临床资料,统计肺部感染发生率、病原菌分布;采用logistic回归方程计算导致肺部感染的独立危险因素。结果 300例脑梗死卧床患者中73例发生肺部感染,感染率24.3%;分离出病原菌59株,其中革兰阴性菌43株占72.8%、革兰阳性菌11株占18.7%、真菌5株占8.5%;年龄≥65岁、存在意识障碍、行气管插管、合并糖尿病、使用呼吸机、卧床时间长、有留置鼻饲管的患者肺部感染发生率显著上升(P<0.05);多因素分析显示,年龄、气管插管、意识障碍、使用呼吸机、卧床时间、留置鼻饲管是导致脑梗死长期卧床患者肺部感染的独立危险因素。结论年龄、气管插管、意识障碍、使用呼吸机、卧床时间、留置鼻饲管是脑梗死长期卧床患者肺部感染的独立危险因素,临床上需要针对感染的危险因素制定针对性的预防措施,并根据病原菌的特点选择敏感性高的抗菌药物,以改善患者预后。

OBJECTIVE To explore the risk factors for pulmonary infections in long-term bedridden patients with cerebral infarction and analyze the distribution of pathogens so as to reduce the incidence of the pulmonary infections.METHODS The clinical data of 300 cerebral infarction patients who were treated in the hospital from Sep2011 to Sep 2014 were retrospectively analyzed,the incidence of pulmonary infections and distribution of pathogens were statistically analyzed,and the independent risk factors for the pulmonary infections were calculated by using logisticregression equation.RESULTS The pulmonary infections occurred in 73 of 300cerebral infarction patients,with the infection rate of 24.3%.A total of 59 strains of pathogens have been isolated,including 43（72.8%）strains of gram-negative bacteria,11（18.7%）strains of gram-positive bacteria,and 5（8.5%）strains of fungi.The incidence of pulmonary infections was remarkably increased in the patients with no less than 65 years of age,disturbance of consciousness,endotracheal intubation,complication of diabetic mellitus,use of ventilator,long bedridden time,or nasogastric feeding tube indwelling（P〈0.05）.The multivariate analysis indicated that the independent risk factors for the pulmonary infections in the long-term bedridden patients with cerebral infarction included the age,endotracheal intubation,disturbance of consciousness,use of ventilator,bedridden time,and nasogastric feeding tube indwelling.CONCLUSION The independent risk factors for the pulmonary infections in the long-term bedridden patients with cerebral infarction include the age,endotracheal intubation,disturbance of consciousness,use of ventilator,bedridden time,and nasogastric feeding tube indwelling.It is necessary for the hospital to formulate the targeted prevention measures according to the risk factors and choose sensitive antibiotics based on the characteristics of the pathogens so as to improve the prognosis of the patients.