NICU卒中患者相关性肺炎影响因素与病原学分析

Investigation on control of risk factors and etiological analysis on pathogenic bacteria related to stroke-associated pneumonia in NICU

目的了解神经重症监护病房(NICU)卒中患者相关性肺炎(SAP)病原菌分布特征以及SAP发生相关影响因素,为SAP防治提供科学依据。方法前瞻性收集2013年1-12月NICU 317例卒中患者临床资料,其中126例发生SAP,采集感染患者下呼吸道分泌物标本进行细菌培养,数据采用SAS 9.1软件进行统计分析,筛检NICU卒中患者发生SAP的危险因素。结果 126例患者发生SAP,感染率为39.75%;共检出168株病原菌,以革兰阴性菌为主,共125株占74.40%;经logistic回归分析显示,高龄、患糖尿病、吞咽困难、胃管使用、呕吐、意识障碍、呼吸机辅助通气等为发生SAP的独立危险因素(P<0.05)。结论 SAP病原菌以革兰阴性菌为主;高龄、胃管使用、呼吸机辅助通气、糖尿病、呕吐、吞咽困难等为影响SAP发生的危险因素,应严密监测SAP病原菌变化,加强防范措施,以减少NICU卒中患者SAP感染的发生。

OBJECTIVE To investigate the distribution of pathogenic bacteria and the risk factors related to stroke‐associated pneumonia （SAP） and to provide the clinical prevention strategies of SAP .METHODS Totally 317 ca‐ses of stroke patients from the NICU during Jan .2013 to Dec .2013 were enrolled ,among whom 126 had SAP . Specimens of lower respiratory tract secretions of infected patients were collected to classify and identify patho‐gens .The software SAS9 .1 was used for statistical analysis of data .The risk factors for SAP in stroke patients were screened .RESULTS Totally 126 patients had SAP and the incidence of SAP was 39 .75% .A total of 168 pathogenic strains were isolated by bacterial culture .The major pathogenic bacteria in SAP were gram‐negative bacteria （125 ,74 .40% ） .The results of logistic regression analysis showed that independent risk factors influen‐cing incidence of SAP included older age ,diabetes mellitus ,dysphagia ,gastric tube ,vomiting ,disturbance of confusion and ventilator assisted ventilation .CONCLUSION The most common pathogens related to SAP are main‐ly gram‐negative bacteria .The major risk factors influencing SAP include older age ,gastric tube ,ventilator assis‐ted ventilation ,diabetes mellitus ,vomiting ,and dysphagia .Clinicians should monitor the pathogenic bacteria of SAP rigorously and strengthen prevention strategies to reduce incidence of SAP in stroke patients .