急性脑梗死继发肺部感染病原菌及危险因素

Pathogens and risk factors in patients with pulmonary infection secondary to acute cerebral infarction

目的探讨急性脑梗死(ACI)继发肺部感染患者病原菌学及相关危险因素。方法对2019年1月-2022年3月天津市第一中心医院收治219例ACI患者的临床资料进行回顾性分析,根据所选患者是否发生肺部感染将其分为未感染组(161例)及感染组(58例)。统计肺部感染患者病原菌学特点,比较两组临床资料,并采用多因素Logistic回归分析法分析ACI继发肺部感染的危险因素。结果从58例肺部感染患者共分离出64株病原菌,其中革兰阴性菌的占比最高(76.56%)。感染组年龄大于未感染组,住院时间>14 d、有吸烟史、肺部疾病史、合并基础疾病、有侵入性操作、低蛋白血症、吞咽功能障碍、入院时美国国立卫生院神经功能缺损(NIHSS)评分>14分的患者占比大于未感染组(P<0.05)。多因素Logistic回归分析结果显示,ACI继发肺部感染的独立危险因素包括有吸烟史、肺部疾病史、年龄大、有侵入性操作、吞咽功能障碍、入院时NIHSS评分>14分(P<0.05)。结论ACI继发肺部感染与有侵入性操作、吞咽功能障碍、入院时NIHSS评分>14分等因素有关,其感染病原菌主要为革兰阴性菌,为减少肺部感染的发生,临床可据此给予患者针对性的治疗及干预措施。

OBJECTIVE To investigate the pathogenic bacteria and related risk factors in patients with acute cerebral infarction(ACI)secondary to pulmonary infection.METHODS The clinical data of 219 patients with ACI admitted to Tianjin First Central hospital from Jan 2019 to Mar 2022 were retrospectively analyzed,and the recruited patients were divided into the non-infection group(161 cases)and the infection group(58 cases)according to whether pulmonary infection occurred.The pathogenic bacteria characteristics in the patients with pulmonary infection were analyzed,and the clinical data between the two groups were compared.Multivariate logistic regression analysis was used to analyze the risk factors for the secondary pulmonary infection in ACI.RESULTS A total of 64 strains of pathogenic bacteria were isolated from 58 patients with pulmonary infection,of which gram-negative bacteria accounted for the highest proportion(76.56%).The age of the infected group was older than that of the non-infected group;the proportion of patients with hospitalization time 14 d,history of smoking,lung disease and underlying diseases,invasive procedures,hypoalbuminemia,swallowing dysfunction,neurological deficit of the score of national institutes of health neurological deficiency(NIHSS)on admission >14 points in the infected group were greater than that of the uninfected group(P<0.05).The results of multivariate logistic regression analysis showed that the independent risk factors for secondary pulmonary infection of ACI included smoking history,history of lung disease,older age,invasive operation,swallowing dysfunction,and score of NIHSS on admission >14 points(P<0.05).CONCLUSION The secondary lung infection of ACI is related to invasive operation,swallowing dysfunction,score of NIHSS>14 at admission.The main pathogens of infection are gram-negative bacteria.To reduce the occurrence of pulmonary infection,the clinically targeted treatment and intervention measures could be given to patients.