老年高血压脑出血患者卒中相关性肺炎病原学特点及危险因素分析

Etiologic features and risk factors of stroke-associated pneumonia in elderly patients with hypertensive intracerebral hemorrhage

目的:以老年高血压脑出血患者为研究对象,探讨老年人群出现卒中相关性肺炎(SAP)的病原学特点及其易感因素。方法:回顾分析收治的224例老年高血压脑出血患者的临床资料,对老年人群发生SAP的病原学及药敏结果进行统计分析,分析导致老年人群发生SAP的危险因素。结果:老年高血压脑出血患者中57.1%(128例)伴发SAP,病死率高达42.9%(96例),其中最多见的病原菌是金黄色葡萄球菌、铜绿假单胞菌和鲍曼不动杆菌,导致感染的独立危险因素包括:年龄≥70岁、吸烟及慢性肺部疾病史、发生误吸、格拉斯哥(GCS)评分≤5、胃管使用≥1周、使用抗生素≥3种、呼吸机使用≥72 h。结论:老年高血压脑出血患者发生SAP的病原体以革兰氏阴性菌为主,年龄≥70岁、吸烟及慢性肺部疾病史、GCS评分≤5、发生误吸、抗生素使用≥3种等因素均与老年患者SAP的发生有关,需引起临床上高度重视,同时应根据患者病原菌药敏结果进行针对性治疗。

Objective:To investigate the etiologic features and susceptibility factors of stroke-associated pneumonia(SAP)in elderly patients with hypertensive intracerebral hemorrhag.Methods:The clinical data of 224 elderly patients with hypertensive intracerebral hemorrhage was retrospectively analyzed,and the etiologic features and antibiotics sensitivity of elderly patients with SAP were observed,then the risk factors for SAP in this population was analyzed.Results:The incidence of SAP in elderly patients with hypertensive intracerebral hemorrha was 57.1%(128 cases),the mortality was 42.9%(96 cases).Staphylococcus aureus,pseudomonas aeruginosa and acinetobacter baumannii were the most common pathogens.Independent risk factors for infection were age≥70 years,history of smoking and chronic pulmonary disease,pulmonary aspiration,GCS score≤5,Gastric tube≥1 week ventilator use≥1 week,antibiotic use≥3,ventilator use≥72 hours.Conclusion:The main pathogens of SAP were gram-negative bacteria.Age≥70 years,history of smoking and chronic pulmonary disease,pulmonary aspiration,GCS score≤5,Gastric tube≥1 week ventilator use≥1 week,antibiotic use≥3 and ventilator use≥72 hours are all related with pulmonary infection.Clinical importance needs to be attached,and specific treatments should be based on the patient’s pathogen-sensitizing results.