老年脑卒中患者卒中相关性感染的危险因素分析

Risk factors analysis of stroke related infections in elderly stroke patients

目的分析老年脑卒中患者发生卒中相关性感染(stroke associated infection,SAI)的危险因素。方法选取2020年7月~2023年3月江苏省人民医院收治的老年脑卒中患者197例。根据感染与否将患者分为感染组与未感染组。对两组一般临床资料、脑卒中相关临床资料及血糖、血红蛋白、白蛋白、超敏C反应蛋白(hs-CRP)、CD3^(+)、CD8^(+)等指标水平进行比较。采用logistic回归分析影响SAI发生的危险因素。结果197例患者中55例(59部位)出现感染,SAI发生率为27.92%,占比前3位的分别是呼吸道感染38.18%、泌尿道感染29.09%、血液感染16.36%。感染组白蛋白、CD3^(+)、CD8^(+)均低于未感染组,空腹血糖(FPG)、hs-CRP水平高于未感染组,差异有统计学意义(P<0.05)。感染组气管插管切开导尿管胃管、应用质子泵抑制剂、洼田饮水试验≥3分、入院美国国立卫生研究院卒中量表(NIHSS)评分>15、格拉斯哥昏迷量表(GCS)评分<9的患者占比高于未感染组,差异有统计学意义(P<0.05)。多因素分析提示CD3^(+)降低,FPG、hs-CRP水平升高,气管插管切开导尿管胃管、应用质子泵抑制剂、入院NIHSS评分>15及GCS评分<9是影响SAI发生的独立危险因素(P<0.05)。结论患者自身因素、医源性因素均影响SAI的发生,对于GCS评分<9分、NIHSS评分>15分、CD3^(+)百分比明显下降、血糖明显升高的老年卒中患者应重点监控,严格执行操作规程,采取综合措施降低感染率。

Objective To analyze the risk factors of stroke associated infection(SAI)in elderly stroke patients.Methods 197 elderly stroke patients admitted to the Jiangsu Provincial People′s Hospital from July 2020 to March 2023 as the study subjects.Calculate the incidence of infection in various parts of the body and divide patients into infected and uninfected groups.Compare two sets of general clinical data,stroke related clinical data,blood glucose,hemoglobin,albumin,hypersensitive C-reactive protein(hs-CRP),CD3^(+),CD8^(+),and other laboratory tests.Use logistic regression to analyze the influencing factors of SAI.Results Among the 197 patients,55 cases(59 sites)developed infections,with a SAI incidence rate of 27.92%,accounting for 38.18%of the respiratory tract,29.09%of the urinary tract,and 16.36%of blood infections,respectively.The levels of albumin,CD3^(+),and CD8^(+)in the infected group were lower than those in the uninfected group,while the levels of FPG and hs CRP were higher than those in the uninfected group(P<0.05).The proportion of patients in the infection group with tracheotomy catheter gastric tube,proton pump inhibitor application,Watian drinking water test≥3 points,NIHSS score>15,GCS score<9 was higher than that in the non infection group,and the difference was statistically significant(P<0.05).Multivariate analysis showed that CD3^(+)decreased,FPG and hs-CRP levels increased,endotracheal intubation catheter gastric tube,proton pump inhibitor application,NIHSS score>15 and GCS score<9 were independent risk factors affecting the occurrence of SAI(P<0.05).Conclusion Both patient′s own factors and iatrogenic factors affect the occurrence of SAI.For elderly stroke patients with GCS score<9,NIHSS score>15,significant decrease in CD3^(+)percentage,and significant increase in blood sugar,it is important to focus on monitoring,strictly follow operating procedures,and take comprehensive measures to reduce infection rates.