重症脑梗死患者肺部感染的危险因素及病原学分析

Risk factors for complication with pulmonary infection in patients with severe cerebral infarction and etiological analysis

目的探讨有效的防治策略,降低重症脑梗死患者肺部感染的发生率,对重症脑梗死合并肺部感染患者进行病原学分析,并探索影响发生合并感染的影响因素,为临床防治提供依据,改善患者的预后状况。方法选取2013年6月-2016年6月在医院治疗的250例重症脑梗死患者为研究对象,对患者进行年龄、性别等一般人口学特征和高血压史、糖尿病史、心脏病史、意识障碍等临床资料收集,进行数据及影响因素分析。结果 250例重症脑梗死患者中,男性占57.6%,平均(58.33±14.96)岁,合并肺部感染的患者有90例,发生率为36.0%,在90例重症脑梗死合并肺部感染患者中共分离出118株病原菌,主要为革兰阴性菌,77株占65.25%,以肺炎克雷伯菌为主,占17.80%,真菌菌株18株占15.25%,以白假丝酵母菌为主,占8.47%,革兰阳性菌23株,占19.50%;患者年龄、糖尿病史、慢性肺部疾病、住院期间误吸、吸烟史、意识障碍等与肺部感染的发生有相关性(P<0.05);年龄≥60岁的患者发生合并感染的风险是<60岁的1.81倍;有糖尿病的患者发生合并感染的风险是无的2.33倍;有吸烟史的患者发生合并感染的风险是无的1.76倍;有发生住院期间误吸病的患者发生合并感染的风险是无的2.67倍;有意识障碍的患者发生合并感染的风险是无的1.85倍。结论在患者住院期间应根据病原菌的属性,选择合适的抗菌药物对患者进行治疗,要同时注意加强对于与感染密切相关的危险因素的关注,尽早采取预防治疗措施,减少患者肺部感染的发生,改善患者症状和预后,提高患者生存质量。

OBJECTIVE To explore the effective prevention strategies to reduce the incidence of pulmonary infection in patients with severe cerebral infarction,perform the etiological analysis of the severe cerebral infarction patients complicated with pulmonary infection,and investigate the influencing factors for complication with pulmonary infection so as to provide guidance for clinical prevention and treatment.METHODS A total of 250 patients with cerebral infarction who were treated in the hospital from Jun 2013 to Jun 2016 were recruited as the study objects.The general demographic characteristics such as age and gender as well as the clinical data,including hypertension history,diabetic mellitus history,cardiac surgery history,and disturbance of consciousness,were collected from the patients;the data and influencing factors were analyzed.RESULTS Of the 250 patients with severe cerebral infarction,57.6% were male patients,with the mean age（58.33±14.96）years old,and 90 patients were complicated with pulmonary infection,with the incidence rate 36.0%.Totally 118 strains of pathogens were isolated from the90 severe cerebral infarction patients complicated with pulmonary infection,including 77（65.25%）strains of gram-negative bacteria,18（15.25%）strains of fungi,and 23（19.50%）strains of gram-positive bacteria;the Klebsiella pneumoniae was dominant among the gram-negative bacteria,accounting for 17.80%;the Candida albicans was the predominant species of fungi,accounting for 8.47%.The incidence of the pulmonary infection was associated with the age,diabetic mellitus history,chronic pulmonary diseases,aspiration during hospital stay,smoking history,and disturbance of consciousness（P〈0.05）.The patients aged no less than 60 years old were1.81 times the risk of complication with infection as the patients aged less than 60 years old;the patients with diabetic mellitus were 2.33 times the risk of complication with infection as the patients without diabetic mellitus;the patients with smoking history were 1.76 times the risk of complication with infection as the patients without smoking history;the patients who had aspiration disease during the hospital stay were 2.67 times the risk of complication with infection as the patients who did not;the patients with disturbance of consciousness were 1.85 times the risk of complication with infection as the patients without disturbance of consciousness.CONCLUSIONIt is necessary for the hospitalized patients to choose appropriate antibiotics for treatment according to the distribution of pathogens,focus on the related risk factors for the infections,and take prevention and treatment measures as early as possible so as to reduce the incidence of pulmonary infection,improve the symptoms and prognosis of the patients,and raise the quality of life.