急性缺血性脑卒中医院感染的影响因素及其对远期预后的影响

Influencing factors of nosocomial infection in acute ischemic stroke patients and the effect on long-term prognosis

目的探讨急性缺血性脑卒中患者医院感染的影响因素及其对远期预后的影响。方法根据是否发生医院感染,将1 662例急性脑梗死患者分为感染组及无感染组。收集患者的临床资料,并进行分析比较。结果与无感染组比较,感染组年龄、住院时间、空腹血糖、NIHSS评分及吸烟史、脑血管病史、消化道出血、侵入性操作、吞咽障碍比率显著升高,GCS评分显著降低(P<0.05~0.01)。两组牛津郡社区卒中研究分型差异有统计学意义(P<0.05),感染组完全前循环梗死(TACI)、后循环梗死(POCI)比率更高。多因素Logistic分析显示,高龄、脑血管病史、消化道出血、意识障碍、神经功能严重缺损、侵入性操作、吞咽障碍、在院时间长、高空腹血糖、TACI和POCI是卒中后医院感染的独立危险因素(均P<0.05)。感染组卒中后1年死亡率及神经功能缺陷程度显著高于无感染组(均P<0.001)。结论高龄、脑血管病史、消化道出血、意识障碍、神经功能严重缺损、侵入性操作、吞咽障碍、在院时间长、高空腹血糖、TACI和POCI是卒中后医院感染的独立危险因素。医院感染对急性缺血性脑卒中患者的远期预后有显著影响。

Objective To explore the influencing factors of nosocomial infection in acute ischemic stroke patients and the effect on long-term prognosis.Methods According to nosocomial infection, 1 662 patients were divided into infection group and non-infection group. The clinical data of patients was investigated, and the data were be compared.Results Compared with those in non-infection group, age, hospitalization time, fasting blood glucose level, NIHSS score and the rates of smoking, history of cerebrovascular diseases, gastrointestinal hemorrhage, invasive operation and dysphagia in infection group were significantly increased, and the GCS score in infection group was significantly decreased(P<0.05-0.01). There was significant difference of Oxfordshire community stroke project between infection group and non-infection group(P<0.05). The rates of total anterior circulation infarct(TACI) and posterior circulation infarct(POCI) in infection group were higher than those in non-infection group. Multivariate Logistic regression analysis showed elderly, history of cerebrovascular diseases, gastrointestinal hemorrhage, disturbance of consciousness, neurological function severe defect, invasive operation, dysphagia, length of ward stay, higher fasting plasma glucose, TACI and POCI were independent risk factors of nosocomial infection after stroke(all P<0.05). The mortality within 1 year after stroke and the degree of neurological impairment in infection group were significantly higher than those in non-infection group(all P<0.001).Conclusions Elderly, history of cerebrovascular diseases, gastrointestinal hemorrhage, disturbance of consciousness, neurological function severe defect, invasive operation, dysphagia, length of ward stay, higher fasting plasma glucose, TACI and POCI are independent risk factors of nosocomial infection after stroke. Nosocomial infection exerts an influence on long-term outcomes of stroke.