脑出血患者微创治疗后肺部感染的流行病学调查

Epidemiological survey of cerebral hemorrhage patients with lung infections after minimally invasive treatment

目的对脑出血患者微创治疗后肺部感染的流行病学行年度性调查,以指导临床预防治疗。方法回顾性分析2014年1-12月61例脑出血行微创治疗患者临床资料,探讨肺部感染发生情况、相关因素、相对危险度、临床表现等流行病学信息,采用SPSS19.0软件对数据进行统计分析。结果 61例患者中发生肺部感染21例,感染率为34.4%;死亡8例,病死率13.1%,肺部感染死亡相对危险度OR=2.643,发病时间多在术后1周内;肺部感染的独立影响因素包括长时间应用呼吸机、入院Glasgow评分≤5分、长期留置胃管、慢性支气管炎肺气肿、年龄≥60岁、多种抗菌药物联用;肺部感染主要病原菌为革兰阴性菌占79.4%,其对头孢曲松、头孢吡肟、环丙沙星耐药性较高;革兰阳性菌则对青霉素、苯唑西林、环丙沙星及亚胺培南耐药性较高。结论脑出血患者微创治疗后极易出现肺部感染,进而增加其病死率,临床需高度重视。

OBJECTIVE To annually investigate the epidemiology of pulmonary infections in patients with cerebral hemorrhage after minimally invasive so as to guide the clinical prevention and treatment .METHODS A retrospec‐tive analysis of clinical of 61 cases cerebral hemorrhage patients with pulmonary infections after minimally invasive treatment was conducted from Jan .to Dec .2014 .The infection status ,related risk factors ,relative risk and clini‐cal manifestations were statistically analyzed by SPSS 19 .0 software .RESULTS Totally 21 cases occurred pulmona‐ry infection ,accounting for 34 .4% ;8 patients died ,accounting for 13 .1% .The relative risk of OR=2 .643 ,time of onset was within 1 week after surgery .The independent factors of pulmonary infection included long time appli‐cation of respirator ,admission Glasgow score less than 5 points ,long indwelling time of gastric tube ,chronic bronchitis and emphysema ,aged over 60 years ,use of multi antibiotics （P〈0 .05） .The main pathogenic bacteria of pulmonary infections were gram negative bacteria ,accounted for 79 .4% .The bacteria were highly resistant to ceftriaxone ,cefepime and ciprofloxacin .Results found that gram‐positive bacteria were highly resistant to penicil‐lin ,oxacillin ,ciprofloxacin and imipenem .CONCLUSION Patients with cerebral hemorrhage are prone to lung in‐fections after minimally invasive treatment which will cause death;hence need to pay high attention to .