脑出血合并肺部感染的危险因素分析  

Analysis of related factors of cerebral hemorrhage complicated with pulmonary infection

作　　者：田林 邓文静[1] 马腾亲 段梦思 TIAN Lin;DENG Wen-jing;MA Teng-qin;DUAN Meng-si(Comprehensive ICU,Zhengzhou East District Branch,the First Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院郑东院区综合ICU,郑州450000

出　　处：《医药论坛杂志》2023年第6期6-10,共5页Journal of Medical Forum

基　　金：河南省医学科技攻关计划项目(SB201904002)。

摘　　要：目的 分析脑出血合并肺部感染(PI)的相关危险因素。方法 回顾性收集110例2017年1月—2021年12月郑州大学第一附属医院治疗的脑出血患者,根据患者是否合并PI分为合并组(n=48)和未合并组(n=62)。统计脑出血合并PI患者的病原菌分布特点,分析脑出血合并PI的单因素,将其中具有统计学意义的因素纳入多因素分析,运用多因素logistic回归法分析脑出血合并PI的危险因素。结果 48例脑出血合并PI患者共培养分离出病原菌56株,其中革兰阳性菌12株,占比为21.43%,以金黄色葡萄球菌为主,占比为16.07%;革兰阴性菌35株,占比为62.50%,以肺炎克雷伯菌为主,占比为23.21%;真菌9株,占比为16.07%,以白色假丝酵母菌为主,占比为12.50%。合并组慢性疾病史、年龄≥65岁、吸烟史、吞咽障碍、住院时间≥20 d、GCS评分≤8分、营养不良、预防性使用抗生素、脑室出血、低蛋白血症占比均高于未合并组,差异有统计学意义(P<0.05);两组性别、机械通气和呕吐比较差异无统计学意义(P>0.05)。将脑出血合并PI作为因变量,将慢性疾病史、年龄、吸烟史、吞咽障碍、住院时间、GCS评分、营养不良、预防性使用抗生素、出血位置和低蛋白血症作为自变量,多因素logistic分析结果显示,慢性疾病史、年龄≥65岁、吸烟史、吞咽障碍、住院时间≥20d、预防性使用抗生素是脑出血患者合并PI的危险因素(OR=5.402、3.639、4.239、5.032、11.169、4.682、4.318,P<0.05)。结论 脑出血患者合并PI的危险因素包括慢性疾病史、年龄≥65岁、吸烟史、吞咽障碍、住院时间≥20 d、预防性使用抗生素和脑室出血等,临床需尽早识别PI的危险因素,并采取积极的预防综合干预措施,以预防脑出血患者合并PI。Objective To explore the related factors of cerebral hemorrhage complicated with pulmonary infection(PI).Methods Totally 110 patients with cerebral hemorrhage admitted to our hospital from January 2017 to December 2021 were retrospectively collected and divided into a combined group(n=48) and an uncombined group(n=62) according to whether the patients were complicated with pulmonary infection.The distribution characteristics of pathogenic bacteria in patients with cerebral hemorrhage complicated with PI were analyzed,and the single factor of cerebral hemorrhage complicated with PI was analyzed.The factors with statistical significance were included in multivariate analysis,and the multivariate logistic regression analysis was used to analyze the risk factors of cerebral hemorrhage complicated with PI.Results A total of 56 strains of pathogenic bacteria were isolated from 48 patients with cerebral hemorrhage and PI,among which 12 strains were Gram-positive bacteria,accounting for 21.43%,and Staphylococcus aureus was the main strain,accounting for 16.07%;35 strains were Gram-negative bacteria,accounting for 62.50%,mainly Klebsiella pneumoniae,accounting for 23.21%;Strains 9 fungi,accounting for 16.07%,mainly Candida albicans,accounting for 12.50%.Chronic disease history,age≥65 years,smoking history,dysphagia,hospital stay≥20 days,GCS score≤8,malnutrition,prophylactic antibiotic use,intraventricular hemorrhage,and hypoalbuminemia in the combined group were all higher than those of uncombined group(P<0.05);but there was no difference in gender,mechanical ventilation and vomiting between the two groups(P>0.05).Intracerebral hemorrhage combined with PI as the dependent variable,chronic disease history,age,smoking history,dysphagia,hospital stay,GCS score,malnutrition,prophylactic antibiotic use,bleeding location and hypoalbuminemia as independent variables,multivariate logistic analysis results showed that the history of chronic diseases,age≥65 years,smoking history,dysphagia,hospitalization time≥20 days,prop

关 键 词：脑出血 预防综合干预 肺部感染 影响因素 病原菌 

分 类 号：R743.34[医药卫生—神经病学与精神病学]