NICU缺血性脑卒中合并鲍曼不动杆菌肺炎的危险因素及预后分析  

Risk factors and prognosis of ischemic stroke patients with acinetobacter baumannii pneumonia in NICU

作　　者：汪霞龄 承欧梅[1] 吴秀书[1] WANG Xia-ling;CHENG Ou-mei;WU Xiu-shu(Department of Neurology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院神经内科,重庆400016

出　　处：《川北医学院学报》2023年第9期1169-1172,共4页Journal of North Sichuan Medical College

基　　金：国家自然科学基金(81471334)。

摘　　要：目的:探讨神经内科重症监护室(NICU)缺血性脑卒中(IS)合并鲍曼不动杆菌(Ab)肺炎患者感染及预后的危险因素。方法:选取134例NICU中IS合并Ab肺炎患者为研究对象,依据是否合并多重耐药性鲍曼不动杆菌(MDRAB)感染分为MDRAB组(n=112)与非MDRAB组(n=22)。依据患者预后结局分为幸存组(n=80)与非幸存组(n=54)。比较患者的耐药情况及一般资料,分析影响NICU中IS患者并发MDRAB肺部感染及不良预后的因素。结果:134例患者中,除阿米卡星(73.9%)、左氧氟沙星(67.9%)和头孢哌酮/舒巴坦(53%)外,Ab对其它药物的耐药率均>75%;MDRAB感染率为83.6%,住院期间全因死亡率为40.3%。在分离Ab前使用碳青霉烯类、β-酰胺酶抑制剂和进行气管插管是MDRAB肺部感染的独立危险因素(P<0.05)。高龄、并发脓毒症休克、呼吸衰竭是患者预后不良的独立风险因素(P<0.05)。结论:在NICU中,IS合并Ab肺炎患者对常用抗菌药物的耐药率较高,高龄且重症MDRAB感染的患者预后较差。Objective:To explore the risk factors and prognosis of ischemic stroke(IS)patients with Acinetobacter baumannii(Ab)pneumonia in neurology intensive care unit(NICU).Methods:134 patients with IS complicated with Ab pneumonia in NICU were selected as the research subjects,and divided into MDRAB group(n=112)and non MDRAB group(n=22)based on whether they were complicated with multidrug-resistant Acinetobacter baumannii(MDRAB)infection.According to the patient's prognosis,they were divided into survival group(n=80)and non-survival group(n=54).The drug resistance status and general information of patients were compared,and the factors that affect the incidence of MDRAB pulmonary infection and poor prognosis were analyzed in IS patients in NICU.Results:Among 134 patients,drug resistance rates exceeded 75%,except for amikacin(73.9%),levofloxacin(67.9%)and cefoperazone/sulbactam(53%).The MDRAB infection rate was 83.6%,and all-cause mortality during hospitalization was 40.3%.Before the Ab was isolated,using of carbapenems,β-amidase inhibitors and performing tracheal intubation were independent risk factors for MDRAB infection(P<0.05).Advanced age,complicated by septic shock and respiratory failure were independent risk factors for the patient's death(P<0.05).Conclusion:IS patients with Ab pneumonia in NICU have a high rate of resistance to frequently used antibiotics,and the patients with advanced age and severe MDRAB infection have a poorer prognosis.

关 键 词：缺血性卒中 鲍曼不动杆菌 多重耐药性 预后 危险因素 

分 类 号：R743.32[医药卫生—神经病学与精神病学]