脑梗死术后患者尿路感染病原学及影响因素  

Etiological characteristics and risk factors of urinary tract infection in patients after cerebral infarction

作　　者：肖淑红[1] 刘建浩[1] 黄文灵 王天磊[1] 王芹 XIAO Shu-hong;LIU Jian-hao;HUANG Wen-ling;WANG Tian-lei;WANG Qin(Sanya Traditional Chinese Medicine Hospital,Sanya,Hainan 572000,China;不详)

机构地区：[1]三亚市中医院针灸科,海南三亚572000 [2]中国人民解放军总医院海南医院神经外科,海南三亚572013

出　　处：《中华医院感染学杂志》2020年第7期1106-1110,共5页Chinese Journal of Nosocomiology

基　　金：海南省自然科学基金资助项目(817399)。

摘　　要：目的探讨行标准大骨瓣减压术或血管内支架置入术术后的脑梗死患者尿路感染病原学分布特征及影响因素。方法前瞻性分析2016年1月-2019年2月于中国人民解放军总医院海南分院行标准大骨瓣减压术或血管内支架置入术的脑梗死患者120例,留取留置导尿管期间或拔除导尿管48 h内患者无菌尿液,进行病原菌培养,根据培养结果分为感染组和未感染组。分析感染组患者病原菌分布,并比较感染组和未感染组患者一般资料、血清炎症因子的差异,分析感染的影响因素。结果纳入的120例患者中,发生尿路感染患者30例,革兰阴性菌检出21株占70.00%,革兰阳性菌检出7株占23.33%,真菌检出2株占6.67%。与未感染组比较,感染组患者白细胞介素-6(interleukin-6,IL-6)[(10.05±2.33)vs(67.89±5.49)](ng/ml)、白细胞介素-8(interleukin-8,IL-8)[(23.39±3.26)vs(207.44±14.83)](ng/ml)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)[(44.33±4.30)vs(131.98±10.04)](ng/ml)及超敏C-反应蛋白(hypersensitive C-reactive protein,hs-CRP)[(3.30±1.04)vs(14.48±3.20)](mg/L)水平均升高,差异均有统计学意义(P<0.05)。单因素分析结果显示,年龄、住院时间、入院时是否有意识障碍、是否持续留置导尿>7 d及是否进行无菌间歇导尿>7 d比较差异有统计学意义(P<0.05)。Logistic回归分析显示,年龄>65岁、住院时间>60 d、入院时伴有意识障碍、持续留置导尿管>7 d、无菌间歇导尿>7 d是脑梗死术后尿路感染发生的影响因素(P<0.05)。结论脑梗死术后尿路感染的影响因素、病原菌分布具有特征性,应给予及时治疗,以提高救治成功率和降低医院感染率。OBJECTIVE To investigate the etiological distribution and risk factors of urinary tract infection in patients with cerebral infarction after standard large bone flap decompression or intravascular stent implantation.METHODS Prospective analysis of 120 patients with cerebral infarction who underwent standard large bone flap decompression or endovascular stenting from January 2016 to February 2019.The pathogenic bacteria were cultured in the urine of the patients during the indwelling catheter or within 48 hours after the catheter was removed.According to the results of culture,they were divided into infected group and uninfected group.The distribution of pathogenic bacteria in the infection group was analyzed,and the general data of the infected group and the uninfected group were compared,and the differences of serum inflammatory factors were compared,and the risk factors of infection were analyzed.RESULTS Among the 120 patients,30 of patients with urinary system infection,21(70.00%)of Gram-negative bacteria,7(23.33%)of Gram-positive bacteria and 2(6.67%)of fungi.Compared with the uninfected group,the levels of interleukin-6(IL-6)[(10.05±2.33)vs(67.89±5.49)](ng/ml),interleukin-8(IL-8)[(23.39±3.26)vs(207.44±14.83)](ng/ml),tumor necrosis factor-α(TNF-α)[(44.33±4.30)vs(131.98±10.04)(ng/ml)]and hypersensitive C-reactive protein(hs-CRP)[(3.30±1.04)vs(14.48±3.20)](mg/L)in the infected group were significantly higher than those in the uninfected group(P<0.05).Univariate analysis showed that age,length of hospitalization,disturbance of consciousness at admission,continuous indwelling catheterization>7 days and sterile intermittent catheterization>7 days were correlated with the occurrence of urinary tract infection(P<0.05).Logistic regression analysis showed that age>65 years,hospitalization time>60 days,continuous indwelling catheter>7 d,sterile intermittent catheter>7 d,accompanied by disturbance of consciousness at admission were the risk factors of postoperative urinary tract infection in patients with cere

关 键 词：脑梗死 尿路感染 病原学特点 影响因素 炎症因子 

分 类 号：R691.3[医药卫生—泌尿科学]