82例脑卒中后长期卧床者并发医院感染的临床分析  

Clinical analysis of nosocomial infection in 82 cases of long periods of bed rest after stroke

作　　者：杨珂珂[1] 徐玉梅[1] 陆咏[1] 

机构地区：[1]上海交通大学附属第一人民医院分院内科,200081

出　　处：《中华全科医学》2014年第8期1205-1207,1268,共4页Chinese Journal of General Practice

摘　　要：目的分析脑卒中后长期卧床患者并发医院感染的发生率、病死率、病原体种类、病原菌分布及其临床特点,明确感染的易感因素,为临床积极防治提供依据。方法回顾性分析了上海交通大学附属第一人民医院分院病房收治的738例脑卒中后长期卧床患者,收集整理其临床和实验室资料,计算医院感染的发生率,对有医院感染患者进行进一步分析,按照有无易感因素分成2组,并将2组患者相关临床和实验室资料进行比较。结果738例脑卒中后长期卧床患者中有82例发生了96例次医院感染,其中12例发生了2种及2种以上的感染,感染的病原体以细菌感染最常见,其次是真菌和病毒感染,感染部位仍以呼吸道最常见,其次为泌尿道。影响感染发生的因素主要与原发病,住院时间,卧床时间,有无导管及合并症,并发症等有关,脑卒中病情越重,住院时间越长,卧床时间越长,其感染发生率越高,留置导管是导致感染发生的独立危险因素,抗生素的滥用是导致真菌感染的主要因素,合并医院感染的患者经积极治疗后,65例好转,17例死亡。结论脑卒中后长期卧床患者是医院感染的好发人群,且感染是该类患者的主要死亡原因之一。积极采用综合防治措施是降低病死率的关键。Objective To analyze the prevalence,mortality,the type of pathogens,pathogenic bacteria distribution and its clinical characteristics of the nosocomial infection in patients with long periods of bed rest after stroke,investigate the predisposing factor, and provide the basis for the prevention and control of nosocomial infection. Methods The clinical and laboratory data of 738 patients with long periods of bed rest after stroke in our hospital were analyzed retrospectively. The incidence of nosocomial infection was calculated. All the patients with nosocomial infection were divided into 2 groups according to the predisposing factors. The data between the two groups were compared.Results The infection occurred in 82 of 738 patients with long periods of bed rest after stroke, in which 12 cases were with two or more kinds of infections; The bacterial infection was the most common, followed by fungus and virus infection;the respiratory tract was the most common infectious sites, followed by urinary tract. The influencing factors of infection were the primary disease, hospitalization time, bed rest time, presence of catheter and complications, and so on. The serious stroke, long hospital stay and long periods of bed rest would raise the incidence of nosocomial infection. The catheter indwelling was the independent risk factors of infection. The abuse of antibiotics was the main factors leading to fungal infection. In patients with nosoco- mial infection,65 cases were improved by the active treatment,but 17 cases were died. Conclusion The patients with long periods of bed rest after stroke are the vulnerable population to nosocomial infections, and the infection is one of the main causes of death. Paying more attentions to the clinic features, and adopting positively integrate control measurement should decrease the fatality rate of these patients.

关 键 词：脑卒中 医院感染 易感因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]