脑卒中患者院内感染的临床特征及相关危险因素分析

The clinical characteristics of nosocomial infection in stroke patients and the analysis of related risk factors

目的研究脑卒中患者院内感染的发生情况及临床特征,分析其发生院内感染的危险因素。方法观察2015年1月至2015年12月本院神经内科收治的360例脑卒中患者的院内感染发生率及院内感染发生的相关危险因素。结果 360例脑卒中患者中发生院内感染55例,感染率为15.28%;标本来源以痰液最多;感染部位以下呼吸道最多;感染菌株中革兰阳性菌30株,占54.55%;革兰阴性菌16株,占29.09%;真菌9株,占16.36%。单因素分析显示:患病季节、意识障碍程度、侵入性操作、血糖水平、低蛋白血症、预防性应用抗生素、糖皮质激素应用是脑卒中患者院内感染的影响因素(P<0.05)。Logistic回归分析显示,患病季节(OR=5.191)、意识障碍(OR=3.515)、侵入性操作(OR=7.478)、血糖水平(OR=16.643)、预防性应用抗生素(OR=4.836)是脑卒中患者发生院内感染的危险因素(P<0.05)。结论脑卒中患者院内感染发生率较高,且院内感染的相关因素较多且复杂,需充分重视相关危险因素,采取综合防治措施减少脑卒中患者院内感染的发生。

Objective To investigate the occurrence and clinical characteristics of nosocomial infection in stroke patients, and analyze its risk factors. Method 360 cases of stroke patients were selected in our hospital from January 2015 to December 2015, and the incidence rate and related risk factors of nosocomial infection were observed. Result A total of 55 cases had nosocomial infection among the 360 cases, and the infection rate was 15.28%; the infection samples were mainly derived from sputum and most infection tooken place in lower respiratory tract. A total of 55 cases of nosocomial infection were deteced, included 30 strains of grampositive coccus（54.55%）, 16 strains of gram-negative coccus（29.09%）, 9 strains of fungi（16.36%）. Related factors analysis showed that age, season, the degree of conscious disturbance, hospital stay, invasive operation, the level of blood glucose, respiratory system disease, hypercholesterolemia, hypoalbuminemia, prophylactic antibiotics, glucocorticoid application were the factors of nosocomial infection in stroke patients（P〈0.05）. Logistic regression analysis showed that sick season（OR = 5.191）, disturbance of consciousness（OR = 3.515）, invasive operation（OR = 7.478）, blood glucose（OR = 16.643）, the prophylactic antibiotics（OR = 4.836） were risk factors of nosocomial infection in stroke patients（P〈0.05）. Conclusion There is high incidence of nosocomial infection in stroke patients, and the related factors of nosocomial infection are complex. Full attention should be paid to related risk factors, and comprehensive prevention, control measures should be adopted to reduce nosocomial infection in stroke patients.