老年缺血卒中相关性肺炎患者危险因素及发生多重耐药菌感染病原学分析

The Clinical Analysis of Risk Factors in Elderly Patients Complicated with Pneumonia after Ischemic Stroke and the Etiology of Multiple Drug-resistant Infection

目的:探讨老年缺血性卒中相关性肺炎患者的临床特征和危险因素及发生多重耐药菌病原学特点。方法:选取老年缺血性卒中后并发肺炎患者136例(肺炎组),未并发肺炎患者136例作为对照(非肺炎组)。分析两组患者临床特征和入院实验指标检查结果差异,及老年缺血性卒中后肺炎的独立危险因素及发生多重耐药菌病原体特点。结果:肺炎组比非肺炎组的住院时间、吞咽障碍、胃管进食、意识障碍(GCSS)、则更低(P<0.05);肺炎组比非肺炎组的白细胞、血糖、血肌酐、尿素氮水平明显更高,红细胞、血红蛋白水平则更低(P<0.05);logistics回归分析结果表明意识障碍(GCSS3-8、9-12分),胃管进食,白细胞水平升高与卒中后患者并发肺炎显著相关(P>0.05)。多重耐药菌68株,前列五位菌株分别为鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯杆菌、肺炎链球菌、金黄色葡萄球菌。结论:意识障碍(GCSS3-8分、9-12分)、胃管进食、白细胞水平升高是老年缺血性卒中相关性肺炎的独立危险因素。此外,老年缺血性卒中相关性肺炎发生多重耐药率较高。

Objective:To analyze the clinical characteristic and independent risk factors of senile ischemic stroke patients complicated with pneumonia and it′s etiology of multiple drug-resistant infection.Methods:A total of 136 elderly ischemic stroke associated pneumonia patients(pneumonia group)and the same number patients of non-pneumonia after ischemic stroke(non-pneumonia group)were selected.The difference of patients’clinical characteristics and laboratory results were compared between the two groups,then the independent factors of elderly ischemic stroke associated pneumonia and it′s etiology of multiple drug-resistant infection were analyzed.Results:The levels of hospital stays,dysphagia,gastric tube feeding,in pneumonia group were higher than non-pneumonia group(P<0.05).The levels of WBC,blood glucose,creatinine,urea nitrogen in pneumonia group were higher than non-pneumonia group,but the levels of RBC and hemoglobin were just the opposite(P<0.05).Logistic regression analysis shows that disturbance of consciousness(GCSS 3-8 and 9-12)、gastric tube feeding,WBC and neutrophils percentage level increased were closely related with elderly ischemic stroke associated pneumonia(P<0.05).Total including 68 multiple drug-resistant strains,and the top 5 strains were Acinetobacter baumannii,pseudomonas aeruginosa,klebsiella pneumoniae,streptococcus pneumoniae and staphylococcus aureus.Conclusion:Disturbance of consciousness(GCSS 3-8 and 9-12),gastric tube feeding,WBC level increased are independent risk factors in elderly ischemic stroke associated pneumonia,and the proportion of the multiple drug-resistant bacteria was high.