老年脑卒中患者并发肺部感染病原学及危险因素分析

Etiology of pulmonary infection in elderly patients with stroke and risk factors

目的探讨分析老年脑卒中患者并发肺部感染的病原学及危险因素,为有效降低老年脑卒中患者发生院内肺部感染提供参考。方法选择2006年7月-2013年7月医院收治的急性脑卒中老年患者325例,采用单因素以及多因素logistic回归分析,对可能影响患者并发肺部感染的各因素进行分析。结果 325例患者中,并发肺部感染患者80例,肺部感染率为24.62%;80例合并肺部感染患者共检出病原菌106株,其中革兰阴性菌75株占70.75%、革兰阳性菌24株占22.64%、真菌7株占6.61%;单因素分析结果显示,年龄、卒中类型、合并基础疾病、意识障碍、吞咽障碍、长期吸烟史、侵入性操作、卧床时间≥14d与老年脑卒中患者肺部感染的发生具有相关性(P<0.05);logistic回归分析显示,合并基础疾病、年龄大、侵入性操作、卧床时间≥14d及意识障碍为影响老年脑卒中患者肺部感染的独立危险因素。结论合并基础性疾病、高龄、侵入性操作、长期卧床以及合并意识障碍是老年脑卒中患者并发肺部感染的独立危险因素,需要引起临床工作者的重视。

OBJECTIVE To explore the etiology of pulmonary infection in elderly patients with stroke and analyze the risk factors so as to effectively reduce the incidence of the nosocomial pulmonary infection in the elderly pa- tients with stroke. METHODS A total of 325 elderly patients with acute cerebral stroke who were treated in hospi- tals from Jul 2006 to Jul 2013 were enrolled in the study. The univariate analysis and multivariate logistic regres- sion analysis were performed for influencing factors for the pulmonary infection in the patients. RESULTS Of the 325 patients, 80 were complicated with pulmonary infection, and the incidence rate of pulmonary infection was 24.62%. Among totally 106 strains of pathogens that were isolated from the 80 patients complicated with pulmo- nary infection, there were 75 （70.75%） strains of gram-negative bacteria, 24 （22. 64%） strains of gram-positive bacteria, and 7 （6.61%） strains of fungi. The results of the univariate analysis indicated that the incidence of pul- monary infection in the elderly patients with stroke was associated with the age, types of stroke, complication with underlying diseases, disturbance of consciousness, dysphagia, long smoking history, invasive operation, and bed- ridden time no less than 14 days （P〈0.05）. The logistic regression analysis showed that the independent risk fac tors for the pulmonary infection in the elderly patients with stroke included the complication with underlying disea- ses, advanced age, invasive operation, bedridden time no less than 14 days, and disturbance of consciousness. CONCLUSION The independent risk factors for the pulmonary infection in the elderly patients with stroke include the complication with underlying diseases, advanced age, invasive operation, long bedridden time, and disturbance of consciousness, to which the clinicians should attach great importance.