急性脑卒中患者肺部感染因素与病原菌分析

Related factors for pulmonary infections in patients with acute stroke and distribution of pathogens

目的分析急性脑卒中患者肺部感染的相关因素,为临床防治提供依据。方法对2011年6月-2014年6月就诊的347例急性脑卒中患者的临床资料进行回顾性分析,对急性脑卒中肺部感染患者的送检标本进行细菌培养和菌株鉴定,分析引发肺部感染的相关因素,采用SPSS13.0统计软件进行统计分析。结果 347例急性脑卒中患者发生肺部感染73例,感染率为21.0%,共分离病原菌83株,其中革兰阴性菌49株占59.0%,以大肠埃希菌和铜绿假单胞菌为主,革兰阳性菌15株占18.1%,以金黄色葡萄球菌为主,真菌19株占22.9%,以白色假丝酵母菌为主;急性脑卒中患者的年龄、卒中类型、肺部疾病史、意识障碍、糖尿病和侵入性治疗等与肺部感染具有相关性(P<0.05)。结论急性脑卒中患者肺部感染是多因素相互作用的结果,感染病原菌以革兰阴性菌为主,临床应采取积极的防治措施,改善患者预后。

OBJECTIVE To analyze the related factors for pulmonary infections in the patients with acute stroke so as to provide guidance for clinical prevention and treatment.METHODS The clinical data of 347 patients with acute stroke who were treated in the hospital from Jun 2011 to Jun 2014 were retrospectively analyzed.The submitted specimens that were obtained from the acute stroke patients complicated with pulmonary infections were cultured,and the isolated strains were identified.The related factors for the pulmonary infections were analyzed,and the statistical analysis was performed with the use of SPSS13.0software.RESULTS Of 347 patients with acute stroke,73 had the pulmonary infections,with the infection rate of 21.0%.A total of 83 strains of pathogens were isolated,including 49（59.0%）strains of gram-negative bacteria,15（18.1%）strains of gram-positive bacteria,and19（22.9%）strains of fungi;the Escherichia coli and Pseudomonas aeruginosa were dominant among the gramnegative bacteria,the Staphylococcus aureus was the predominant species of the gram-positive bacteria,and the Candida albican was the major species of the fungi.The pulmonary infections in the patients with acute stroke were associated with the age,types of stroke,history of pulmonary disease,disturbance of consciousness,diabetic mellitus,and invasive treatment（P〈0.05）.CONCLUSION The interaction of the multiple factors may result in the pulmonary infections in the patients with acute stroke.The gram-negative bacteria are dominant among the pathogens.It is necessary for the hospital to take positive prevention measures so as to improve the prognosis of the patients.