急性脑卒中患者医院获得性呼吸道感染的临床分析

Clinical analysis on hospital acquired respiratory tract infection in patients with acute stroke

目的探讨急性脑卒中患者医院获得性呼吸道感染的相关因素,为预防感染提供依据。方法回顾性分析2013年4月-2015年3月医院收治203例急性脑卒中患者的临床资料,对可能影响患者并发医院获得性呼吸道感染的相关因素、病原菌进行分析,同时分析医院获得性感染对患者预后的影响。结果 203例急性脑卒中患者共发生医院获得性呼吸道感染92例,感染率45.32%;92例患者送检标本中共分离出病原菌60株,其中以革兰阴性菌为主占53.33%,其次为革兰阳性菌占35.00%,真菌占11.67%;急性脑卒中患者发生医院获得性呼吸道感染与其年龄、卒中类型、有意识障碍、吞咽障碍、侵入性操作、卧床时间、基础疾病、应用抗菌药物等存在密切关系,组间比较差异有统计学意义(P<0.05);多因素分析显示,卒中类型、合并基础疾病、侵入操作、卧床时间、意识障碍等为急性脑卒中患者发生医院获得性呼吸道感染的独立危险因素,差异有统计学意义(P<0.05);感染患者病死率12.00%低于未感染患者1.80%,差异有统计学意义(P<0.05)。结论急性脑卒中患者发生医院获得性呼吸道感染的独立危险因素较多,医院获得性呼吸道感染可对患者功能恢复及预后产生影响;发生感染者病原菌多以条件致病菌居多,临床治疗时应根据药敏结果及时调整抗菌药物,以控制感染。

OBJECTIVE To investigate the influencing factors for hospital acquired respiratory tract infection in acute stroke patients,so as to provide the prevention of infection.METHODS Clinical data of 203 patients with acute cerebral stroke admitted by the hospital from Apr.2013 to Mar.2015 were retrospectively analyzed,related factors and pathogens of complicated hospital acquired respiratory tract infection of patients possibly to be affected were analyzed,and at the same time,and the influences of hospital acquired infection on the prognosis of patients were analyzed.RESULTS There were 92 cases of hospital acquired respiratory infection occurred in 203 cases of acute cerebral stroke patients,with the infection rate of 45.32%.Totally 60 strains of pathogens were isolated from the specimens,mainly gram-negative bacteria,accounting for 53.3%,gram-positive bacteria accounted for35.0%,and 11.7%fungal infection.The age,types of stroke,disturbance of consciousness,swallowing disorders,invasive procedures,time in bed,underlying diseases,and use of antimicrobial drugs had close relationship with hospital acquired respiratory tract infection in patients with acute stroke,and the difference between groups was significant（P〈0.05）.The multivariate analysis showed that the types of stroke,combined with underlying diseases,invasive operation,bed time,and consciousness disorders were independent risk factors of hospital acquired respiratory tract infection in patients with acute stroke（P〈0.05）.The mortality rate of infected patients was 12.00%,which was lower than 1.80% of uninfected patients（P〈0.05）.CONCLUSIONThere are lots of independent risk factors for hospital acquired respiratory infection of patients with acute cerebral stroke,and the hospital acquired respiratory tract infection may affect the function recovery and prognosis of patients.A majority of pathogenic bacteria of patients infected are conditional pathogens,and the drug resistance is serious,timely adjustment should be made according to results of drug susceptibility of antibiotics in clinical treatment to control the infection.