重型缺血性卒中患者肺部感染的诊断与治疗研究  

Diagnosis and treatment of patients with severe ischemic stroke and lung infection

作　　者：蔡谋善[1] 沈春林[2] 查运红[1] 曾令海[1] 宋承伟[1] 

机构地区：[1]宜昌市第一人民医院神经内科,湖北宜昌443000 [2]宜昌市第一人民医院手术室,湖北宜昌443000

出　　处：《中华医院感染学杂志》2015年第20期4703-4705,共3页Chinese Journal of Nosocomiology

基　　金：湖北省自然科学基金资助项目(2011CDB512)

摘　　要：目的探讨重型缺血性卒中发生肺部感染患者的病原菌分布及其诊断治疗方法,为重型缺血性卒中患者预防、诊治及控制肺部感染提供临床依据。方法选取医院2013年1月-2015年1月收治的158例发生肺部感染的重型缺血性卒中患者为观察组,另选同期100例无肺部感染的重型缺血性卒中患者为对照组,检查所有患者(1-3)-β-D-葡聚糖、血清降钙素原(PCT)和超敏C-反应蛋白(hs-CRP)水平,并对发生肺部感染患者进行痰液培养。结果 158例发生肺部感染重型缺血性卒中患者痰液标本中培养出病原菌182株,其中革兰阳性菌78株、革兰阴性菌104株,分别占42.87%和57.13%;单菌种感染134例,多菌种混合感染24例,分别占84.81%和15.19%;158例肺部感染患者治疗总有效率为98.10%;观察组(1-3)-β-D-葡聚糖、PCT和hs-CRP水平显著高于对照组,差异有统计学意义(P<0.01);治疗30d后,观察组和对照组综合治疗总有效率分别为90.51%和93.00%,两组比较差异无统计学意义。结论重型缺血性卒中并发肺部感染患者病原菌中,革兰阴性菌检出率高于革兰阳性菌,检测(1-3)-β-D-葡聚糖、PCT和hs-CRP水平对于诊断肺部感染具有重要意义。OBJECTIVE To investigate the pathogenic bacteria distribution and treatment method for patients with severe ischemic stroke and lung infection ,so as to provide guideline for preventing ,treatment and controlling of lung infection .METHODS Totally 158 cases of patients with severe ischemic stroke and lung infection in our hospi‐tal from Jan .2013 to Jan .2015 were selected as observation group and another 100 cases without lung infection were chosen as control group .The level of （1 ,3）‐β‐D‐glucan ,serum procalcitonin （PCT ） ,high sensitive C （hs‐CRP） reaction protein were determined and sputum bacteria cultivation experiments were conducted .RESULTS 182 strains of pathogenic bacteria were detected in sputum samples from 158 cases ,including 78 strains of gram‐posi‐tive bacteria and 104 strains of gram‐negative bacteria ,accounting for 42 .86% and 57 .14% ,respectively .A total of 134 cases of patients were proved to be single bacterial infection ,and 24 cases of patients were proved to be multi‐bacterial infection .The total effective rate was 98 .10% .The total effective rate of patients with gram‐posi‐tive bacteria ,gram‐negative bacteria and mixed bacteria were 100 .00% ,100 .00 and 87 .50% ,respectively .The level of （1 ,3）‐β‐D‐glucan ,PCT and hs‐CRP of observation group were significantly higher than that of control group （P〈0 .01） .After treatment for 30 days ,the comprehensive effective rate of observation group and control group were 90 .51% and 93 .00% ,without significant difference .CONCLUSION The gram‐negative bacteria detec‐tion rate was significantly higher than that of gram‐positive bacteria .Detection of the level of （1 ,3）‐β‐D‐glucan , PCT and hs‐CRP will help to deduce the lung infection .Treatment should comply with the drug sensitivity test .

关 键 词：缺血性卒中 肺部感染 病原菌 药敏试验 

分 类 号：R563.1[医药卫生—呼吸系统]