脑卒中患者医院获得性肺炎危险因素分析与预防  

Risk factors and preventive methods for nosocomial pneumonia after acute stroke

作　　者：姜海波[1] 阮肇扬[2] 王小川[1] 叶小军[1] 卢晓东[1] 

机构地区：[1]杭州师范大学附属医院神经内科,浙江杭州310015 [2]杭州师范大学附属医院呼吸科,浙江杭州310015

出　　处：《中华医院感染学杂志》2016年第12期2706-2708,共3页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(30570536)

摘　　要：目的了解脑卒中患者医院获得性肺炎的发生率,统计分析其发生的危险因素,为临床预防与治疗脑卒中患者医院获得性肺炎提供指导依据。方法选择2010年4月-2015年3月医院神经内科收治的1 500例脑卒中患者,将其中发生医院获得性肺炎患者的痰液送检,分析感染病原菌构成,筛查脑卒中患者发生院内获得性肺炎的危险因素,数据采用SPSS 19.0软件进行统计分析。结果 1 500例脑卒中患者中有44例发生医院获得性肺炎,发生率为2.93%;共检出病原菌71株,其中以革兰阴性菌为主,51株占71.83%,革兰阳性菌19株占26.76%,真菌1株占1.41%;logistic回归分析显示,气管切开、气管插管、使用呼吸机、预防性使用抗菌药物、合并糖尿病、吞咽困难和鼻饲胃管等是导致脑卒中患者发生医院获得性肺炎的独立危险因素(P<0.05)。结论导致脑卒患者医院获得性肺炎的病原菌以革兰阴性菌为主,患者发生医院获得性肺炎的危险因素较多,在临床治疗中,对于存在高风险因素的脑卒中患者要密切关注,给予必要干预措施,预防和减少医院获得性肺炎的发生。OBJECTIVE To learn the incidence of nosocomial pneumonia after acute stroke,analyze the risk factors,so as to provide guidance for clinical prevention and treatment.METHODS The clinical data of 1500 patients with acute stroke enrolled in department of neurology of our hospital from Apr.,2010 to Mar.2015 were analyzed.The sputum samples of patients with nosocomial pneumonia were collected for analysis of bacterial distribution.The risk factors for stroke-associated pneumonia were screened.All the data were analyzed with SPSS 19.0software.RESULTS Among the 1500 patients with stoke,44 suffered from nosocomial pneumonia and the infection rate was 2.93%.Totally 71 strains of pathogens were detected including 51 strains of gram-negative bacteria,19 strains of gram-positive bacteria,and 1strain of fungus,accounting for 71.83%,26.76%,and 1.41%,respectively.Logistic regression analysis showed that tracheotomy,intubation,ventilator,prophylactic use of antibiotics,diabetes,dysphagia,and nasogastric tube were independent risk factors for nosocomial pneumonia after acute stroke（P〈0.05）.CONCLUSION The main pathogens involved in nosocomial pneumonia after acute stroke are gram-negative bacteria and there are many risk factors involved in stroke-associated pneumonia.It is necessary to pay close attention to the patients with risk factors,give necessary interventions to prevent and reduce the incidence of nosocomial pneumonia after acute stroke.

关 键 词：脑卒中 患者 医院获得性肺炎 危险因素 病原菌 预防措施 

分 类 号：R743.3[医药卫生—神经病学与精神病学]