脑出血并医院获得性肺炎52例临床分析

Clinical Analysis on Hospital-acquired Pneumonia in 52 Patients with Cerebral Hemorrhage

目的:探讨脑出血患者医院获得性肺炎(HP)的相关危险因素及其病原学特点。方法:回顾分析我院2011年1月-2013年12月脑出血患者208例的临床资料,根据有无并发HP分为A组和B组,比较两组患者的性别、年龄、基础疾病、病情,A组的病原菌种类及其耐药率。结果:本组脑出血患者HP发病率为25.0%。年龄≥65岁,基础疾病≥2种,合并糖尿病、慢性阻塞性肺疾病(COPD),GSC评分<8,气管切开,鼻饲,吸痰和住院≥7 d是脑出血患者HP的高危因素。52例HP患者的下呼吸道分泌物标本中共分离出致病菌72株,其中革兰氏阴性菌49株(68.0%),革兰氏阳性菌19株(26.4%),真菌4株(5.6%)。革兰氏阴性菌以铜绿假单胞菌、肺炎克雷伯菌、嗜麦芽窄食单胞菌及大肠埃希菌为主;革兰氏阳性菌以金黄色葡萄球菌为主。铜绿假单胞菌和肺炎克雷伯菌对头孢菌类的耐药率高,对喹诺酮类药物的耐药率较低;金黄色葡萄球菌对青霉素、红霉素的耐药率高,对头孢菌类的耐药率低。结论:关注脑出血患者HP的高危因素,监测病原菌,合理使用抗生素。

Objective ：To explore the risk factors of hospital-acquired pneumonia（HP） in the patients with cerebral hemorrhage,and analyze its etiology characteristics. Methods ：The clinical data of 208 patients with cerebral hemorrhage were retrospectively analyzed from Jan 2011 to Dec 2013. The cases were divided into group A（pneumonia group）and group B（no pneumonia group） according to the presence of HP,then the clinical characteristics of gender,age,underlying diseases,state of an illness were analyzed and between the two groups,while the kinds of pathogenic bacteria,main drug resistance were also analyzed in group A. Results ：The incidence of HP was 25.0%（52 / 208）among the patients with cerebral hemorrhage. Age ≥65 years,basic diseases ≥2 kinds, diabetes,chronic obstructive pulmonary disease（COPD）,GSC score 8,tracheotomy,nasal feeding,sputum suction and hospitalization days ≥7d were the risk factors. 72 strains pathogenic bacteria were isolated in lower respiratory tract secretions of the 52 patients with HP,including 49 strains of Gram-negative bacteria（68.0%）, 19 strains Gram-positive bacteria（26.4%）and 4strains fungus（5.6%）. The main bacterias were Pseudomonas aeruginosa,Klebsiella pneumoniae, Stenotrophomonas maltophilia and E. coli bacterium in the Gram-negative bacteria,and were given priority to with Staphylococcus aureus in Gram-positive bacteria. Pseudomonas aeruginosa and Klebsiella pneumonia resisted to cephalosporins fungi highly,to quinolones lowly,and Staphylococcus aureus were resistance to penicillin,erythromycin highly and to cephalosporins fungi lowly. Conclusions ：Doctors should pay close attention to risk factors of HP in patients with cerebral hemorrhage,monitor pathogens and use antibiotics rationally.