急性脑梗死老年患者肺部感染的病原学特征及影响因素分析  

Etiological characteristics of pulmonary infection in elderly patients with acute cerebral infarction and influencing factors

作　　者：张瑜 贺利峰[2] 汤永国 冯马龙 周纪东 ZHANG Yu;HE Li-feng;TANG Yong-guo;FENG Ma-long;ZHOU Ji-dong(People＇s Hospital of Fenghua Area Ningbo City,Ningbo,Zhejiang 315500,China)

机构地区：[1]宁波市奉化区人民医院神经内科,浙江宁波315500 [2]湖州市中心医院神经内科,浙江湖州313003 [3]宁波市奉化区人民医院呼吸内科,浙江宁波315500 [4]宁波市奉化区人民医院ICU,浙江宁波315500

出　　处：《中华医院感染学杂志》2018年第13期1947-1950,共4页Chinese Journal of Nosocomiology

基　　金：浙江省卫生科技计划基金资助项目(2016RCB020)

摘　　要：目的探讨急性脑梗死老年患者肺部感染的病原学分布特征、影响因素及对预后的影响,为临床有效防治提供理论依据。方法回顾性分析2015年3月-2017年3月医院神经内科住院治疗的年龄>60岁急性脑梗死患者200例,分析肺部感染率,检测感染患者感染病原菌类型,并行药敏分析。单因素分析老年急性脑梗死患者发生肺部感染的相关因素;多因素逻辑回归分析并筛选影响预后的独立影响因素。结果 200例老年急性脑梗死患者中,80例发生肺部感染,感染率为40%。共培养出98株病原菌,其中革兰阴性菌75株占76.53%,革兰阳性菌17株占17.35%,真菌6株占6.12%。排名前4位的病原菌依次为肺炎克雷伯菌、铜绿假单胞菌、鲍氏不动杆菌和金黄色葡萄球菌。男性、重度脑梗死、合并糖尿病和肺部疾病、昏迷、吞咽功能障碍、肺部感染前行侵入性治疗是患者发生肺部感染的影响因素;合并糖尿病、昏迷和肺部感染前行侵入性治疗是影响患者预后的独立影响因素。结论老年急性脑梗死患者肺部感染病原菌以革兰阴性菌为主,应根据培养及药敏结果合理应用抗菌药物;患者发生肺部感染与多种因素相关,需采取积极的防治措施。OBJECTIVE To explore the etiological characteristics of pulmonary infection in elderly patients with acute cerebral infarction and observe the impact of influencing factors on prognosis so as to provide theoretical basis for effective clinical prevention and treatment.METHODS A total of 200 patients with acute cerebral infarction who were more than 60 years old and hospitalized in neurology department from Mar 2015 to Mar 2017 were retrospectively analyzed,the incidence of pulmonary infection was analyzed,the species of pathogens causing the infection were identified,the result of drug susceptibility resting was analyzed,the univariate analysis was performed for the related factors for the pulmonary infection,and multivariate logistic regression analysis was carried out for the independent influencing factors for the prognosis.RESULTS Of the 200 elderly patients with cerebral infarction,80 had pulmonary infection,with the infection rate 40%.Totally 98 strains of pathogens were isolated,75（76.53%）of which were gram-negative bacteria,17（17.35%）were gram-positive bacteria,and 6（6.12%）were fungi.The pathogens that ranked the top 4 species were as the following：Klebsiella pneumoniae,Pseudomonas aeruginosa,Acinetobacter baumannii,Staphylococcus aureus.The influencing factors for the pulmonary infection included male,severe cerebral infarction,complication with diabetes mellitus and pulmonary diseases,coma,dysphagia and invasive operation before pulmonary infection.The complication with diabetes mellitus,coma and invasive operation before pulmonary infection were the independent influencing factors for the prognosis of the patients.CONCLUSIONThe gram-negative bacteria are dominant among the pathogens causing the pulmonary infection in the elderly patients with acute cerebral infarction.It is necessary to reasonably use antibiotics based on the result of the drug susceptibility resting,there are a variety of factors that are associated with the pulmonary infection,and the active prevention measures should b

关 键 词：急性脑梗死 肺部感染 病原菌 影响因素 预后 

分 类 号：R378[医药卫生—病原生物学]