老年慢性卒中后肺炎的临床特征及预后因素  

Clinical aspects and prognostic factors of senile chronic-onset post-stroke pneumonia

作　　者：吴倩[1] 丁启翠[2] 宋国栋[1] 王伟[1] 

机构地区：[1]山东大学第二医院呼吸内科,济南250033 [2]临沂市人民医院呼吸内科,山东临沂276000

出　　处：《山东大学学报（医学版）》2013年第5期75-79,共5页Journal of Shandong University:Health Sciences

摘　　要：目的探讨老年慢性卒中后肺炎的临床特征、病原学及相关预后因素,为疾病的诊治提供依据。方法从2008年1月～2010年8月入住山东大学第二医院呼吸内科、>65岁的340例老年肺炎患者中,筛选出符合诊断标准的老年慢性卒中后肺炎及单纯老年性肺炎患者各60例,采用专用登记表,收集患者资料并进行统计分析。结果与单纯老年性肺炎患者相比,老年慢性卒中后肺炎患者一般情况差,常合并多种慢性病,其血液白细胞水平更高,动脉血氧分压更低,且住院时间较长,预后较差;老年慢性卒中后肺炎患者中合并吞咽障碍者,预后较差;老年慢性卒中后肺炎患者病原学检查以革兰阴性菌居多,最常见为大肠埃希菌,其次为铜绿假单胞菌、肺炎克雷伯菌,同时合并革兰阳性菌及真菌感染的概率亦较高;机械通气及鼻饲是老年慢性卒中后肺炎患者预后的独立危险因素。结论老年慢性卒中后肺炎患者一般情况、化验指标及预后较单纯老年性肺炎患者差,病原学复杂,初始选择抗生素治疗时应注意覆盖可能的致病菌,给予足量、足疗程治疗,并可适当选用具有神经保护作用的抗生素;机械通气及鼻饲为影响预后的独立危险因素。Objective To explore the clinical aspects, pathogens, and prognostic factors of senile chronic-onset poststroke pneumonia. Methods 60 patients with senile chronic-onset post-stroke pneumonia and 60 patients with general senile pneumonia were selected from the total of 340 patients（ 〉 65 years old） who were hospitalized in the department of respiratory diseases, the second hospital of Shandong university, from Nov. 2008 to Aug. 2010. All the medical data of the sdected patients were collected and compared by a special enrollment, followed by an analysis with SPSS 17.0 soft- ware. Results Compared with general senile pneumonia patients, senile chronic-onset post-stroke pneumonia patients showed much worse general conditions, higher frequency being accompanied by other diseases, higher blood leukocyte count and lower arterial partial pressure of oxygen. They needed longger hospital stays and had poorer outcome. While, the outcomes of senile chronic-onset post-stroke pneumonia patients who had dysphagia were worse than those who didn＇t. Among senile chronic-onset post-stroke pneumonia patients, they were likely to find gram-negtive bacteria at the first sputum cultures, particularly Escherichia coli, followed by pseudomonas aeruginosa, and Klebsiella pneurnoni- ae, while they had higher risk of acquiring gram-positive bacteria and fungi infections. Both mechanical ventilation and nasal feeding were independent risk factors. Conclusion Senile chronic-onset post-stroke pneumonia patients have much worse general conditions, test results and prognosis, complexed pathogens. It was necessary to initially choose antibiotics with broad spectrum to cover all the possible pathogens, and the treatment should have sufficient dose and duration. Additionally, the antibiotics with neuroprotective effects were recommended. Mechanical ventilation and nasal feeding are independent risk factors for their outcomes.

关 键 词：卒中 肺炎 老年 病原学 预后 

分 类 号：R563.1[医药卫生—呼吸系统]