老年脑卒中假性球麻痹致肺部感染的病原学特点  

Etiology characteristics analysis of pseudo bulbar paralysis causing lung infection in elderly stroke

作　　者：石际俊[1] 章春园[1] 曹勇军[1] 

机构地区：[1]苏州大学附属第二医院神经内科卒中病房,江苏苏州215004

出　　处：《中华医院感染学杂志》2014年第7期1688-1690,共3页Chinese Journal of Nosocomiology

基　　金：国家自然基金青年项目(81200894);苏州市科技发展计划指导项目(SYSD2012083)

摘　　要：目的：探讨老年脑卒中假性球麻痹致肺部感染的病原学特点，为临床用药提供指导。方法选择神经内科卒中单元病房2012年1月-2013年1月21例老年脑卒中假性球麻痹致肺部感染患者作为研究对象进行回顾性分析，统计数据采用SPSS 13．0进行处理。结果21例老年脑卒中假性球麻痹致肺部感染患者检出病原菌22株，以革兰阴性菌为主占68．2％；前5位的病原菌为肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌、鲍氏不动杆菌、金黄色葡萄球菌，分别占27．3％、13．6％、13．6％、9．1％、9．1％；泛耐药鲍氏不动杆菌仅对亚胺培南、万古霉素较敏感，对其他抗菌药物100．0％耐药；21例患者经积极治疗后，19例患者的感染在5～8 d内得到控制，死亡2例，均死于脑卒中伴多器官功能衰竭，病死率9．52％。结论老年脑卒中假性球麻痹后容易并发肺部感染，针对感染病原菌，足量、早期、联合使用敏感抗菌药物，同时积极治疗原发病，加强多频振动排痰、营养支持、吞咽困难筛查和吞咽功能训练等是控制感染，降低病死率的有效方法。OBJECTIVE To study etiology characteristics of pseudo bulbar paralysis causing lung infection in elderly stroke ,so as to provide reference to guide clinical medication .METHODS A total of 21 cases of elderly patients with pseudo bulbar paralysis causing lung infection in stroke were selected as subjects for retrospective analysis from neurology stroke unit ward in our hospital from Jan .2012 to Jan .2013 .SPSS 13 .0 was used for processing statistical data .RESULTS A total of 22 strains of pathogens were detected from the 21 cases of elderly patients with pseudo bulbar paralysis causing lung infection in stroke ,and mainly were gram-negative bacteria ,accounting for 68 .2% ;The top five pathogens were K lebsiella pneumoniae , Pseudomonas aeruginosa , Escherichia coli , Acinetobacter baumannii and Staphylococcus aureus ,espectiuely accounting for 27 .3% ,13 .6% ,13 .6% ,9 .1%and 9 .1% .Susceptibility test results showed that extensively drug-resistant A .baumannii were sensitive to imi-penem and vancomycin ,and 100% resistant to other antibiotics .All of the 21 patients were treated actively ,and 19 patients infections were under control within 5~8 d ,2 patients died of stroke with multiple organ failure in the fatality rate 9 .52% .CONCLUSION Pseudo bulbar paralysis causing lung infection in elderly stroke is easily com-plicated by pulmonary infection .Because of that ,sensitive antimicrobial agents should be used in full dose ,early and combined .At the same time ,primary disease should be treated actively ,multiple frequency vibration row of phlegm ,nutritional support , dysphagia screening and swallowing function training are the effective ways to control infection and reduce mortality .

关 键 词：老年患者 脑卒中 假性球麻痹 肺部感染 病原学分析 用药指导 

分 类 号：R563[医药卫生—呼吸系统]