老年脑卒中相关性肺炎病原学特点及危险因素分析

Etiology features and risk factors of stroke-associated pneumonia in elderly patients

目的探讨老年脑卒中相关性肺炎(SAP)的病原学特点及危险因素。方法对239例老年脑卒中患者的慢性基础疾病、意识状态、有无侵入性操作、病原学检查结果、药物使用情况等临床资料进行回顾性调查,比较分析SAP的病原学特点及相关危险因素。结果 239例老年脑卒中患者发生SAP 56例,感染率为23.4%,例次感染率为26.8%,感染病原菌以革兰氏阴性杆菌为主,占65.0%,排在前三位的病原菌依次是铜假绿单胞菌(23.8%)、鲍蔓不动杆菌(16.3%)、肺炎克雷伯菌(15.0%)。住院天数≥30 d、有侵入性操作、有意识障碍、使用多种抗菌药物、有慢性基础病等是SAP的危险因素。结论老年脑卒中患者是SAP的高危人群,应重点监测,控制相关危险因素,积极采取个性化的预防措施,以有效地降低SAP的发生率。

Objective To investigate the etiology features and risk factors of stroke-associated pneumonia( SAP) in elderly patients. Methods A retrospective study was performed to analyze the clinical characteristics,the etiology features and risk factors in 239 elderly patients with SAP. The clinical characteristics included chronic basic diseases,state of consciousness,invasive operation,results of pathogens tests and medication. Results Among 239 cases,56 infected with SAP. The infection rate was 23. 4% and the case-time infection rate was 26. 8%. The responsible pathogens were gram negative bacteria,accounting for 65. 0%,which included Pseudomonas aeruginosa( 23. 8%),Bauman acinetobacter( 16. 3%) and Klebsiella pneumoniae( 15. 0%). Hospitalization ≥30 days,invasive operation,disturbance of consciousness,multiple antibiotics therapy and chronic basic diseases were the risk factors of SAP. Conclusion Elderly patients are susceptible to SAP. Increasing the awareness of controlling the risk factors and administering appropriate therapy help to prevent the development of SAP in the elderly.