急性缺血性脑卒中相关性肺炎患者耐药性分析  

Analysis of Drug Resistance in Patients with Acute Ischemic Stroke-related Pneumonia

作　　者：许江飞[1] 周海燕[1] 王宽红[1] XU Jiangfei;ZHOU Haiyan;WANG Kuanhong(Department of Neurology, Xinxiang Central Hospital, Xinxiang Henan 453000, China)

机构地区：[1]新乡市中心医院神经内科,河南新乡453000

出　　处：《河南医学高等专科学校学报》2022年第2期135-139,共5页Journal of Henan Medical College

基　　金：河南省医学科技攻关计划项目(2018020869)。

摘　　要：目的探讨急性缺血性脑卒中相关性肺炎患者耐药性及疾病特点。方法选取646例急性缺血性脑卒中患者,其中并发相关性肺炎患者96例(观察组),未并发相关性肺炎患者550例(对照组)。收集患者临床特征、人口学特征、实验室检查结果等一般资料,并对病原菌分布情况与致病耐药性进行分析。结果年龄、吸烟史、心房纤颤、卒中史、意识障碍、吞咽困难、机械通气、气管切开或插管、使用脱水剂、鼻饲治疗为急性缺血性脑卒中相关性肺炎患者影响单因素;鲍曼不动杆菌、G-杆菌、肺炎克雷伯菌菌株数分别为34、106、36株,占比依次为21.8%、23.1%、67.9%,其中肺炎克雷伯菌菌株占比最高;铜绿假单胞菌、金黄色葡萄球菌、肺炎克雷伯菌、鲍曼不动杆菌4种病原菌耐药率较高,鲍曼不动杆菌对替加环素耐药敏感,耐药率为0.0%,铜绿假单胞菌对阿米卡星较敏感,金黄色葡萄球菌对环丙沙星、苯唑西林、左氧氟沙星耐药率高达90.0%。结论急性缺血性脑卒中相关性肺炎患者影响单因素为年龄、吸烟史、心房纤颤、卒中史、意识障碍、吞咽困难、机械通气、气管切开或插管、使用脱水剂、鼻饲治疗,革兰阴性菌为主要病原菌,对药物耐药性较普遍,临床应依据药敏结果与病理学特征选择具体抗菌药物。疾病危险因素与耐药性探究可为患者临床治疗提供有效理论依据,有利于治疗措施地制定,临床应用可行性较高。Objective To investigate the drug resistance in patients with acute ischemic stroke-related pneumonia.Methods A total of 646 patients with acute ischemic stroke were selected,including 96 patients with associated pneumonia(observation group)and 550 patients without associated pneumonia(control group).The general information including clinical characteristics,demographic characteristics and laboratory test results were collected,and the distribution and drug resistance of pathogenic bacteria were analyzed.Results Age,smoking history,atrial fibrillation,history of stroke,disturbance of consciousness,dysphagia,mechanical ventilation,tracheotomy or intubation,use of dehydrating agents and nasogastric feeding were the single factors influencing acute ischemic stroke-related pneumonia.The number of strains of Acinetobacter baumannii,G-bacillus,and Klebsiella pneumoniae were 34,106,and 36 cases,respectively,accounting for 21.8%,23.1%,and 67.9%,of which Klebsiella pneumoniae accounted for the highest proportion.Pseudomonas aeruginosa,Staphylococcus aureus,Klebsiella pneumoniae and Acinetobacter baumannii had high resistance rates.Acinetobacter baumannii was sensitive to tigecycline,with a resistance rate of 0.0%.Pseudomonas aeruginosa was more sensitive to amikacin,and Staphylococcus aureus was resistant to ciprofloxacin,oxacillin and levofloxacin as high as 90.0%.Conclusion Single factors affecting acute stroke-related pneumonia include age,smoking history,atrial fibrillation,history of stroke,disturbance of consciousness,dysphagia,mechanical ventilation,tracheostomy or intubation,use of dehydrating agents and nasogastric feeding.Gram-negative bacteria are the main pathogenic bacteria,and drug resistance is common.In clinical practice,specific antibiotics should be selected based on drug susceptibility results and pathological characteristics.The exploration of disease risk factors and drug resistance can provide an effective theoretical basis for the clinical treatment,which is conducive to the formulation of treatment

关 键 词：急性缺血性脑卒中 相关性肺炎 耐药性 疾病特点 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R446.5[医药卫生—临床医学]