脑梗死患者肺部感染特点与多因素logistic回归分析  

Characteristics of pulmonary infections in patients with cerebral infarction and multivariate logistic regression analysis

作　　者：马传花[1] 柯绍发[1] 冉刚[2] 倪红[1] 江毅卿[1] 

机构地区：[1]台州医院神经内科,浙江台州317000 [2]台州医院放射科,浙江台州317000

出　　处：《中华医院感染学杂志》2017年第10期2214-2217,共4页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科技计划基金资助项目(2013ZHB011)

摘　　要：目的探讨脑梗死患者伴肺部感染特点,并对相关因素加以分析,为临床防止脑梗死患者发生肺部感染提供参考。方法选取2014年1月-2016年8月医院住院治疗的500例脑梗死患者,将未发生感染的患者作为对照组,发生肺部感染的患者为观察组;对患者临床病例资料、诊治情况等加以分析,对脑梗死患者伴肺部感染发生因素加以分析,并对有统计学意义的单因素行logistic多因素回归分析,同时对感染患者进行痰液培养,了解其病原菌分布。结果 500例脑梗死患者中发生肺部感染32例,感染率为6.4%;经痰液检测发现,32例脑梗死伴肺部感染患者共检出病原菌40株,其中革兰阴性菌28株占70.0%;革兰阳性菌9株占22.5%;真菌3株占7.5%;主要病原菌为铜绿假单胞菌、大肠埃希菌、金黄色葡萄球菌;观察组患者PH值为(7.05±0.02)明显低于对照组(7.51±0.07);PaO_2为(7.98±2.01)KPa明显低于对照组(10.36±0.71)KPa;PaCO_2为(6.19±0.57)KPa明显高于对照组(5.27±0.31)KPa;TNF-α为(0.27±0.02)μg/L明显高于对照组(0.07±0.02)μg/L;IL-6为(0.27±0.14)μg/L明显高于对照组(0.08±0.04)μg/L,以上指标两组比较,差异均有统计学意义(P<0.05);单因素分析发现,吸烟、使用呼吸机、气管插管、卧床时间、留置鼻饲管、慢性心功能不全、侵入性操作、意识障碍、年龄、糖尿病、肌力Ⅱ级以下、COPD、球麻痹为脑梗死患者伴肺部感染的影响因素;经多因素logistic回归分析发现,年龄、侵入性操作、气管插管、卧床时间、意识障碍、留置鼻饲管、使用呼吸机、糖尿病、肌力Ⅱ级以下、COPD、球麻痹为脑梗死患者伴肺部感染的高危因素。结论脑梗死患者伴肺部感染的影响因素较多,临床医师需加强对脑梗死患者病情的观察,减少侵入性操作等,制定合理有效防治对策,同时根据病原菌特点积极选择合理抗菌药物,以更好的改善患者预后。OBJECTIVE To explore the characteristics of pulmonary infections in patients with cerebral infarction and analyze the related factors so as to provide guidance for clinical prevention of pulmonary infections in the patients with cerebral infarction.METHODS A total of 500 patients with cerebral infarction who were hospitalized for treatment from Jan 2014 to Aug 2016 were enrolled in the study,the patients without infection were assigned as the control group,and the patients with pulmonary infection were set as the observation gruop,then the clinical data,status of diagnosis and treatment of the patients were analyzed,the related factors for the pulmonary infections in the cerebral infarction patients were observed,multivariate logistic regression analysis was performed for the single factor with statistical significance,the sputum culture was carried out for the patients with infections,and the distribution of pathogens was observed.RESULTS Of the 500 patients with cerebral infarction,32 had the pulmonary infections,with the infection rate 6.4 %.The result of sputum culture showed that totally 40 strains of pathogens were isolated from 32 cerebral infarction patients complicated with pulmonary infections,including 28 （70.0%） strains of gram-negative bacteria,9 （22.5%） strains of gram-positive bacteria,and 3 （7.5%） strains of fungi.The Pseudomonas aeruginosa,Escherichia coli,and Staphylococcus aureus were the major species of pathogens.The pH value of the observation group was （7.05±0.02）,significantly lower than （7.51 ±0.07） of the control group（P〈0.05）;the PaO2 of the observation group was （7.98 ± 2.01）KPa,significantly lower than （10.36±0.71）KPa of the control group（P〈0.05）;the PaCO2 of the observation group was （6.19±0.57）KPa,significantly higher than （5.27 ±0.31）KPa of the control group（P〈 0.05）;the TNF-α level of the observation group was （0.27±0.02）μg/L,significantly higher than （0.07±0.02）μg/L of the control group（P〈0.05）;the IL-

关 键 词：脑梗死 肺部感染 病原菌 影响因素 对策 

分 类 号：R563.1[医药卫生—呼吸系统]