脑卒中后遗症期患者并发肺炎病原学特征及其影响因素

Etiological characteristics and influencing factors of patients with pneumonia and stroke sequelae

目的观察脑卒中后遗症期患者并发肺炎病原学特征,分析其影响因素,为未来脑卒中后遗症期患者并发肺炎的早期预防、干预提供参考。方法回顾性收集2010年4月至2020年3月北京市和平里医院确诊并接受治疗的97例脑卒中后遗症期患者并发肺炎作为肺炎组;同期131例脑卒中后遗症患者未发生肺炎作为无肺炎组;记录脑卒中后遗症期患者并发肺炎的病原学特征,设计基线资料填写表,仔细查阅患者相关资料并记录研究所需基线资料,将可能的影响因素纳入,经单因素、多因素分析找出可能导致脑卒中后遗症患者并发肺炎的影响因素。结果脑卒中后遗症期患者并发肺炎感染病原菌以肺炎克雷伯菌、金黄色葡萄球菌、白色假丝酵母菌为主,分别占31.96%、21.65%、15.46%;经单因素分析、后建立多元回归模型行多因素分析,结果显示,合并糖尿病、有鼻饲治疗史、预防性使用抗生素、预防性使用胃黏膜保护剂均是脑卒中患者并发肺炎的影响因素(OR=2.449、2.114、6.933、3.234,P<0.05)。结论肺炎克雷伯菌、金黄色葡萄球菌、白色假丝酵母菌是脑卒中后遗症期患者并发肺炎主要感染病原菌,而合并糖尿病、有鼻饲治疗史、预防性使用抗生素、预防性使用胃黏膜保护剂可能是脑卒中后遗症期患者并发肺炎的影响因素,临床应重视伴有上述风险因素的脑卒中后遗症期患者的早期肺炎预防,可能对降低肺炎发生率、改善患者预后意义重大。

Objective To observe the etiological characteristics in patients with pneumonia and stroke sequelae,to analyze the influencing factors of patients with stroke combined with pneumonia,to provide reference for the early prevention and intervention of patients with pneumonia and stroke sequelae in the future.Methods A retrospective analysis was conducted.The data of 97 patients with pneumonia and stroke sequelae diagnosed and treated in the hospital from April 2010 to March 2020 were collected and included in the pneumonia group;in the same period,131 patients with stroke in sequelae stage without pneumonia were included in the non-pneumonia group;recorded the etiological characteristics of patients with pneumonia and stroke sequelae,designed baseline information filling form,carefully reviewed the relevant patient data and recorded the baseline data required for the study,included possible influencing factors,through univariate and multivariate analysis,the factors that might cause pneumonia in patients with stroke sequelae were found out.Results The pathogens of patients with pneumonia and stroke sequelae were mainly Klebsiella pneumoniae,Staphylococcus aureus,and Candida albicans,31.96%,21.65%,15.46%respectively;after single factor analysis,a multiple regression model was established for multi-factor analysis,the results showed that diabetes mellitus,a history of nasal feeding,preventive use of antibiotics,and preventive use of gastric mucosal protective agents were all influencing factors for patients with pneumonia and stroke sequelae(OR=2.449,2.114,6.933,3.234,P<0.05).Conclusion Klebsiella pneumoniae,Staphylococcus aureus,and Candida albicans are the main pathogens of infection in patients with pneumonia and stroke sequelae.Diabetes mellitus,a history of nasal feeding,preventive use of antibiotics,and preventive use of gastric mucosal protective agents may be the influencing factors of patients with pneumonia and stroke sequelae.Clinical attention should be paid to the early prevention of in patients with pneumonia and stroke sequelae with the above risk factors,which may be of great significance to reduce the incidence of pneumonia and improve the prognosis of patients.