重症脑卒中患者肺感染的病原学分析及早期气管切开疗效的研究

Analysis of the etiology of severe stroke patients with pulmonary infection and the efficacy of early tracheotomy

目的研究分析重症缺血性脑卒中和出血性脑卒中患者肺感染情况,以及探讨早期有气管切开指征的患者行气管切开的疗效。方法对选取2012年1月-2013年12月包头医学院第一附属医院ICU的78例重症脑卒中（其中脑出血患者40例,脑梗死患者38例）且并发肺感染患者的年龄、疾病种类、感染病原菌、以及对有气管切开指征行气切后疗效进行回顾性分析。结果 78例脑卒中合并肺感染患者,其中76例为革兰阴性菌感染,占感染的比例为97.4%;革兰阳性菌为12例,占感染的比例为15.4%;真菌为8例,占感染的比例为10.3%。在重症脑卒中肺感染患者中,病原菌以大肠埃希菌、肺炎克雷伯杆菌、铜绿假单胞菌等革兰阴性菌致病菌为主。气管切开对有气管切开适应证的脑出血患者的疗效优于有气管切开适应证的脑梗死的患者（P〈0.05）。结论了解重症脑卒中肺感染病原学情况,并根据其病原菌特点合理应用抗生素,恰当的选择气管切开改善血氧饱和度,对重症脑卒中患者有重要的临床现实意义。

Objective To explore the etiology of severe stroke patients with pulmonary infection and the efficacy of early tracheotomy in department of neurology.Methods A total of 78 patients of severe stroke with pulmonary infection（including 40 patients with cerebral hemorrhage, cerebral infarction 38 cases） in department of intensive care unit of first affiliated hospital of Baotou medical college from January 2012 to December 2013. The patient＇s age,disease types,and pathogenic bacteria types in the 78 patients were retrospectively analyzed and the efficacy of early tracheotomy for patients who have Tracheotomy indications were also retrospectively evaluated. Results Among 78 stroke patients with pulmonary infection： 76 cases of Grand-negative bacterial infections, infections of the proportion accounted for 97.4%; 12 cases of Grand-positive bacteria was 15.4%; 8 cases of fungus, accounting for the proportion of infection was 10.3%. In severe stroke patients with pulmonary infection, Escherichia coli, pneumonia grams Klebsiella pneumoniae, Pseudomonas aeruginosa bacteria leather among gram negative bacilli pathogens are mainly pathogenic bacteria. The effect of tracheotomy on cerebral hemorrhage is better than that of cerebral infarction（P〈0.05）. Conclusion Understanding the etiology of pulmonary infection in severe stroke patients and according to the characteristics of pathogenic bacteria, the choice of appropriate tracheotomy improve blood oxygen saturation, rational use of antibiotics and proper selection of tracheotomy indications of patients are very important for patients with severe stroke.