脑梗死患者长期卧床肺部感染病原菌与影响因素分析

Clinical analysis of pulmonary infection in patients with long-term bed rest after cerebral infarction

目的探讨脑梗死患者长期卧床发生肺部感染的病原菌和影响因素,以期指导临床治疗。方法回顾性分析2015年8月-2017年8月于医院接受治疗的脑梗死患者121例的临床资料。患者入院后均接受常规治疗,统计患者肺部感染情况,对感染患者病原菌进行分析。对感染与未感染患者动脉血氧分压(PaO2)、二氧化碳分压(PaCO2)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)进行分析;分析患者的性别、年龄、抗菌药物的使用情况、家族史、合并高血压、心脏病、吸烟史、意识障碍、侵入性操作等临床资料,归纳脑梗死后长期卧床患者肺部感染的影响因素。结果脑梗死后长期卧床患者肺部感染率为22.31%(27/121);共培养分离病原菌32株,其中革兰阴性菌21株占65.63%,革兰阳性菌6株占18.75%,真菌5株占15.63%。铜绿假单胞菌对环丙沙星和哌拉西林的耐药性较强,未检出对亚胺培南和美罗培南耐药的菌株;金黄色葡萄球菌对青霉素G、头孢唑林、甲氧嘧啶、左氧氟沙星的耐药性较强,对替考拉宁敏感。感染患者PaCO2、IL-6和TNF-α分别为(6.24±0.86)kPa、(0.30±0.13)μg/L和(0.29±0.08)μg/L高于未感染患者,而PaO2为(7.77±1.90)kPa低于未感染患者(P<0.05);年龄、合并糖尿病是脑梗死后长期卧床患者肺部感染的影响因素(P<0.05)。结论脑梗死后长期卧床患者肺部感染病原菌以革兰阴性菌为主,临床上应据此制定针对性治疗和护理方案。

OBJECTIVE To investigate the pathogens and risk factors of pulmonary infection in long-term bedridden patients with cerebral infarction,so as to guide clinical treatment.METHODS The clinical data of 121 patients with cerebral infarction treated in our hospital from Aug.2015 to Aug.2017 were retrospectively analyzed.All patients received routine treatment after admission.The pulmonary infection of patients was counted and the pathogens of infected patients were analyzed.The arterial partial pressure of oxygen(PaO2),partial pressure of carbon dioxide(PaCO2),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)in infected and uninfected patients were analyzed.The clinical data such as gender,age,use of antibiotics,family history,hypertension,heart disease,smoking history,consciousness disorder and invasive operation were analyzed,and the influencing factors of pulmonary infection in long-term bedridden patients after cerebral infarction were summarized.RESULTS The pulmonary infection rate was 22.31%(27/121)in long-term bedridden patients after cerebral infarction,and 32 strains of pathogens were isolated,of which 21 were gram-negative bacteria(65.63%),6 were gram-positive bacteria(18.75%)and 5 were fungi(15.63%).Pseudomonas aeruginosa was highly resistant to ciprofloxacin and piperacillin,and no strains resistant to imipenem and meropenem were detected.Staphylococcus aureus was highly resistant to penicillin G,cefazolin,methoxine and levofloxacin and sensitive to teicoplanin.PaCO2,IL-6 and TNF-αlevels in infected patients were(6.24±0.86)kPa,(0.30±0.13)μg/L and(0.29±0.08)μg/L,respectively,higher than those in uninfected patients,while the PaO2 level was(7.77±1.90)kPa,significantly lower than that of uninfected patients(P<0.05).Age and diabetes mellitus were the influencing factors of pulmonary infection in patients with long-term bed rest after cerebral infarction(P<0.05).CONCLUSION Gram-negative bacteria are the main pathogens of pulmonary infection in patients lying in bed for a long time after cerebral infarction,and targeted treatment and nursing regimen should be developed accordingly in clinic.