急性重症脑血管病患者感染性并发症的临床分析  

Clinical analysis of infection complication in patients with severe actue stroke

作　　者：李美英[1] 夏峰[1] 丁绍青[1] 苏建华[1] 汤华萍[1] 陈炼[1] 凤兆海[1] 毕茂芳[1] 郑颖伟[1] 陶开香[1] 

机构地区：[1]东南大学医学院附属马鞍山市人民医院神经内科,马鞍山243000

出　　处：《安徽医学》2009年第2期128-131,共4页Anhui Medical Journal

摘　　要：目的探讨急性重症脑卒中患者住院期间感染性并发症的临床特点。方法对54例符合入选标准的急性重症脑出血或脑梗死患者的临床资料进行系统回顾,分析入组患者各种感染并发症的发生率、病原学检查结果以及其他一般临床资料,并采用Logistic回归分析与感染并发症发生相关的各种因素。结果患者住院第2周的总感染并发症发生率较第1周时显著增高(39%vs52%,P<0.05),主要以肺部和尿路感染(41%)为主,部分患者还并发败血症(9%);感染病原体以革兰氏阴性(G-)杆菌和革兰氏阳性(G+)球菌感染为主,其次为真菌感染;药敏试验提示细菌对头孢类、万古霉素、亚胺培南和喹诺酮类比较敏感。感染并发症的发生与患者住院时间、营养不良发生率、NIHSS评分、GCS昏迷量表评分、Barthel指数ADL评分密切相关(r分别为5.62、4.39、8.68、6.26和4.34;均P<0.05)。结论急性重症卒中患者住院期间感染并发症发生率高,严重影响患者的预后,其发生与患者住院时间、营养不良、神经功能缺损以及意识障碍程度密切相关。Objective To investigate the clinical features of infection complication in patients with severe actUe stroke during admission. Methods 54 cases of severe cerebral infarction or haemorrhage enrolled were systematically analyzed, the incidence rate of infection complications and aetiology results were observed, and the relationship between infection complications and different related factors by Logistic regression analysis. Results The incidence rate of infection complications was higher during the second week of admission than that of the first week（39% vs 52%,P〈0.05）, mainly the lungs and urinary tract infections （41%）, some patients also complicated by septicemia （9%）;Pathogens for the most past were Gram-negative （G-） bacteria and gram-positive （G＋） coceobacteria infection, and followed for fungal infections;Sensitivity test of bacteria was indicated to more sensitive to cephalosporins, vancomyein, imipenem and quinolones. The incidence rate of infection complications was closely related to length of patient stay, malnutrition, degree of neurologie impairment and conscious disturbance and Barthel Index of ADL（r=5.62,4.39,8.68,6.26,4.34; all P〈0.05）. Conclusion The incidence rate of infection complication in patients with severe actue stroke during admission was so high that to grately effect clinical outcome, and closely related to length of patient stay, malnutrition, degree of neurologic impairment and conscious disturbance.

关 键 词：脑卒中 感染 并发症 

分 类 号：R743.3[医药卫生—神经病学与精神病学]