老年急性卒中患者肺部感染的危险因素分析

Analysis on risk factors for pulmonary infection in elderly patients with acute stroke

目的探讨老年急性卒中患者肺部感染的危险因素。方法选取该院2017年2月至2018年12月收治的164例急性卒中患者作为研究对象,其中治疗阶段中出现肺部感染患者84例(感染组),未见肺部感染者80例(对照组),收集所有患者年龄、性别及住院时间等相关因素展开统计,同时采用Logistic多因素分析影响肺部感染的危险因素,并了解肺部感染患者病原菌分布及构成。结果两组患者在年龄、意识障碍、卒中类型、吞咽障碍、侵入性操作、H2受体阻滞剂使用、抗菌药物使用、糖皮质激素使用、合并症(免疫系统疾病、糖尿病)、格拉斯哥昏迷(GCS)评分、神经功能受损(NIHSS)评分、住院时间、血糖水平等方面比较,差异有统计学意义(P<0.05);经多因素Logistic回归分析结果发现,NIHSS评分、合并症(免疫系统疾病、糖尿病)、卒中类型与侵入性操作是影响肺部感染的独立危险因素(P<0.05);急性卒中患者肺部感染84例患者中共分离出病原菌98株,病原菌分布以革兰阴性菌为主(54.08%),革兰阳性菌占32.65%,真菌占13.27%。其中2种细菌同时发生感染患者3例(3.57%),3种细菌同时发生感染者2例(2.38%)。结论合并症、NIHSS评分、卒中类型与侵入性操作是诱发卒中患者发生肺部感染的危险因素,临床中需有效对危险因素进行干预,控制肺部感染率。

Objective To explore the risk factors for pulmonary infection in elderly patients with acute stroke.Methods A total of 164 patients with acute stroke in hospital from February 2017 to December 2018 were enrolled,including 84 patients with pulmonary infection during the treatment(the infected group)and 80 patients without pulmonary infection(the control group).The age,gender and hospitalization time of all selected patients were collected for statistics analysis.Logistic multivariate analysis was used to analyze the risk factors of pulmonary infection,and analyzed the distribution and composition of pathogens in patients with pulmonary infection.Results The differences in age,disturbance of consciousness,stroke type,dysphagia,invasive procedure,H2 receptor blockers,antibiotics,glucocorticoid,comorbidities(immune system diseases,diabetes),glasgow coma scale(GCS)scores,national instiutes of health stroke scale(NIHSS)scores,length of hospital stay,and blood glucose levels were statistically significant(P<0.05).Multivariate Logistic regression analysis found that NIHSS scores,comorbidities(immune system diseases,diabetes),stroke type and invasive procedure were independent risk factors for pulmonary infection(P<0.05);98 strains of pathogenic bacteria were isolated from 84 patients with acute stroke.The distribution of pathogens accounted for 54.08%of Gram-negative bacteria,32.65%of Gram-positive bacteria,and 13.27%of fungi.Among them,3 cases accounted for 3.57%of the patients with simultaneous infection of two types of bacteria,and 2 cases accounted for 2.38%of three types.Conclusion Comorbidities,NIHSS score,stroke type and invasive operation are risk factors for pulmonary infection in stroke patients.In clinical practice,risk factors should be effectively intervened to control lung infection rate.