出血性脑卒中患者发生院内感染的临床情况及免疫功能对其预后影响研究

Clinical Situation of Nosocomial Infection in Patients with Hemorrhagic Stroke and the Influence of Immune Function on Prognosis

目的探讨出血性脑卒中患者发生院内感染的临床情况,并分析免疫功能对患者预后的影响,为临床中治疗提供依据。方法选取2016年4月—2018年9月就诊的出血性脑卒中患者265例,将院内感染患者分为感染组(n=32),未发生院内感染患者分为非感染组(n=224),记录出血性脑卒中患者院内感染发生率、病原菌构成,同时采用单因素、多因素Logistic回归分析对导致患者出现医院感染的因素进行分析;比较患者免疫功能指标IgG、IgA、IgM变化。结果256例患者中有32例患者发生院内感染,发生率为12.50%,以下呼吸道为主,其次为泌尿系统、血液;32例感染患者中分离出病原菌50株,以革兰阴性菌为主,占60.00%,其次为革兰阳性菌,占30.00%,最后为真菌,占10.00%。年龄、意识障碍、侵入性操作、抗生素预防应用、住院天数、糖尿病、吸烟史、糖皮质激素应用是导致出血性脑卒中患者发生院内感染的危险因素(P<0.05);经Logistic分析,结果显示,年龄、意识障碍、侵入性操作、抗生素预防应用、住院天数、糖尿病、吸烟史、糖皮质激素应用是导致患者出现院内感染的独立危险因素(P<0.05)。治疗后,两组患者免疫功能指标均有下降,但感染组患者免疫功能指标IgG、IgA、IgM低于非感染组(P<0.05)。结论出血性脑卒中患者院内感染发生率高,受多种因素影响,应充分重视相关因素,采取有效措施预防减少院内感染发生,且提高患者免疫功能可减少感染发生,改善患者预后。

Objective To investigate the clinical situation of nosocomial infection in patients with hemorrhagic stroke,and to analyze the influence of immune function on the prognosis of patients,so as to provide basis for clinical treatment.Methods 265 patients with hemorrhagic stroke treated in Tianjin Ninghe District Hospital from April 2016 to September 2018 were divided into infected group(n=32)and non-infected group(n=224).The incidence of nosocomial infection and pathogenic bacteria composition in patients with hemorrhagic stroke were recorded.Univariate and multivariate Logistic regression were used to analyze nosocomial infection.The factors of infection were analyzed and the changes of IgG,IgA and IgM were compared.Results Among 256 patients,32 patients had nosocomial infection,the incidence was 12.50%.The lower respiratory tract was dominant,followed by urinary system and blood.50 strains of pathogenic bacteria were isolated from 32 patients,mainly Gram-negative bacteria,accounting for 60.00%,followed by Gram-positive bacteria,accounting for 30.00%,and finally fungi,accounting for 10.00%.Age,disturbance of consciousness,invasive operation,antibiotic prophylaxis,hospitalization days,diabetes mellitus,smoking history and glucocorticoid application were risk factors for nosocomial infection in patients with hemorrhagic stroke(P<0.05).Logistic analysis showed that age,disturbance of consciousness,invasive operation,antibiotic prophylaxis,hospitalization days,diabetes mellitus,smoking history,and glucocorticoid application were independent risk factors for nosocomial infection(P<0.05).After treatment,the immune function indexes of both groups decreased,but the immune function indexes IgG,IgA and IgM of the infected group were lower than those of the non-infected group(P<0.05).Conclusion The incidence of nosocomial infection in patients with hemorrhagic stroke is high,which is influenced by many factors.Full attention should be paid to the relevant factors and effective measures should be taken to prevent and reduce nosocomial infection.Enhancing the immune function of patients can reduce the incidence of infection and improve the prognosis of patients.