神经重症监护病房卒中相关性肺炎的预测因素与临床特点  

Stroke-associated Pneumonia in Neurological Intensive Care Unit:Risk Factors and Clinical Characteristics

作　　者：张道培[1] 闫福岭[1] 徐海清[1] 袁宝玉[1] 朱奕昕[1] 

机构地区：[1]东南大学临床医学院东南大学附属中大医院神经内科,江苏南京210009

出　　处：《中华医院感染学杂志》2008年第8期1072-1075,共4页Chinese Journal of Nosocomiology

摘　　要：目的探讨神经重症监护病房中急性脑卒中患者卒中相关性肺炎(SAP)的发生率、发病时间、危险因素及病原学特点。方法回顾分析医院2005年7月-2006年10月神经重症监护病房中的急性脑卒中患者,探讨SAP的危险因素,并分析其病原学特点及死亡率。结果神经重症监护病房中SAP发生率为40.8%,其中的55.4%为早发性肺炎;有卒中病史、呛咳症状、APACHEⅡ评分≥20分及脑干/小脑卒中的患者,早发性肺炎的发生率较高;有心影增大、肺部疾病、昏迷及呛咳症状的患者,晚发性肺炎的发生率较高;病程中不同时间点痰培养检出的菌株中以真菌最多,占42.5%,主要是白色假丝酵母菌;革兰阴性杆菌占34.2%,主要是大肠埃希菌;革兰阳性球菌23.3%,主要是金黄色葡萄球菌;发生SAP的患者死亡率高达32.1%。结论神经重症监护病房中SAP发生率高,真菌感染率高,死亡率高;多发生在住院后的72 h内;早发性与晚发性肺炎的危险因素不同。OBJECTIVE To ascertain the incidence, time of onset, risk factors and microorganism of stroke- associated pneumonia（SAP） in acute critical stroke patients admitted to a neurological intensive care unit（NICU）. METHODS We retrospectively investigated the acute stroke patients treated in the NICU of Zhongda Hospital affiliated to Southeast University between Jul 2005 and Oct 2006. Infections occurring within the first 72 hours of NICU admission were defined as early-onset pneumonia （EOP）, after 72 hours were defined as late-onset pneumonia （LOP）. We studied the risk factors of EOP and LOP respectively, and the characteristics of microorganism and mortality were discussed as well. RESULTS The frequency of SAP was 40.8%, in which EOP accounted for 55. 4%. The patients with stroke history, bucking symptom, APACHE Ⅱ≥ 20 scores and brainstem/cerebellum stroke increased the risk of EOP; the stroke with concomitant cardiac dilatation, pulmonary disease, coma and bucking symptom increased the chance of LOP. Fungus was the first place in the total strains obtained by sputum culture, in which Candida albicans was in the most, occurring in 42.5%; Escherichia coli was a predominant role in the Gram-negative bacilli, holding 23.30%. Staphylococcus aureus was a leading part in the Gram-positives, accounting for 34. 20%. The mortality was 32. 1% in the SAP patients. CONCLUSIONS The incidence rate,fungal infection and mortality of SAP are quite high in acute critical stroke patients admitted to NICU. The risk factors are different between EOP and LOP.

关 键 词：神经重症监护病房 卒中相关性肺炎 危险因素 病原菌 

分 类 号：R181.32[医药卫生—流行病学]