急性缺血性脑卒中患者介入术后肺部感染病原菌分布现状及其相关危险因素分析  

Analysis of Distribution Status and Related Risk Factors of Pathogenic Bacteria of Pulmonary Infection in Patients with Acute Ischemic Stroke after Interventional Therapy

作　　者：吴珊[1] 林国立[1] WU Shan;LIN Guoli(Affiliated Hospital of Putian University,Putian 351100,China;不详)

机构地区：[1]莆田学院附属医院,福建莆田351100

出　　处：《中外医学研究》2023年第25期167-171,共5页CHINESE AND FOREIGN MEDICAL RESEARCH

摘　　要：目的:探究急性缺血性脑卒中(AIS)患者介入术后肺部感染病原菌分布现状及其相关危险因素。方法:选取2021年3月—2022年8月莆田学院附属医院收治的89例AIS患者作为研究对象,所有患者均接受血管内介入治疗,统计介入术后肺部感染发生率、病原菌分布情况及其药敏试验结果,分析AIS患者介入术后肺部感染病原菌分布现状、药敏结果及其相关危险因素。结果:89例AIS患者中,22例发生肺部感染,发生率为24.72%。发生肺部感染的AIS患者痰培养分离出病原菌28株,以革兰阴性菌19株(67.86%)为主,按占比高低依次为肺炎克雷伯菌(28.57%)、铜绿假单胞菌(17.86%)、大肠埃希菌(14.29%)、鲍氏不动杆菌(7.14%)。主要革兰阴性菌肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌对头孢唑林、左氧氟沙星、氨苄西林耐药率均较高,对头孢哌酮/舒巴坦、亚胺培南、哌拉西林/他唑巴坦较敏感。术后发生肺部感染患者合并COPD、合并糖尿病、侵入性操作、意识障碍与术后未发生肺部感染患者比较,差异有统计学意义(P<0.05);两者性别、年龄、体重指数、介入治疗类型比较,差异无统计学意义(P>0.05)。logistic回归分析显示,合并COPD、合并糖尿病、侵入性操作、意识障碍均是AIS患者介入术后发生肺部感染的危险因素(OR>1,P<0.05)。结论:AIS患者介入术后肺部感染发生率较高,其致病菌以革兰阴性菌肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌为主,合并COPD、合并糖尿病、侵入性操作、意识障碍是AIS患者介入术后发生肺部感染的危险因素,临床可依据肺部感染的相关危险因素采取针对性预防措施,并参考致病菌药敏试验结果合理应用抗生素,以减少肺部感染的发生。Objective:To explore the distribution status and related risk factors of pathogenic bacteria of pulmonary infection in patients with acute ischemic stroke(AIS)after interventional therapy.Method:A total of 89 patients with AIS who admitted to Affiliated Hospital of Putian University from March 2021 to August 2022 were selected as the study subjects.All patients were given intravascular interventional therapy.The incidence of pulmonary infection,the distribution of pathogenic bacteria and the results of drug sensitivity test were counted,and the distribution of pathogenic bacteria,drug sensitivity results and related risk factors were analyzed.Result:Among 89 AIS patients,22 patients had pulmonary infection,the incidence rate was 24.72%.A total of 28 strains of pathogenic bacteria were isolated from sputum culture of AIS patients with pulmonary infection,mainly 19 strains(67.86%)of Gram-negative bacteria,followed by Klebsiella pneumoniae(28.57%),Pseudomonas aeruginosa(17.86%),Escherichia coli(14.29%),Acinetobacter baumannii(7.14%).The main gram-negative bacteria Klebsiella pneumoniae,Escherichia coli and Pseudomonas aeruginosa had high resistance rates to Cefazolin,Levofloxacin and Ampicillin,and which were sensitive to Cefoperazone/Sulbactam,Imipenem and Piperacillin/Tazobactam.There were significant differences in COPD,diabetes,invasive operation and disturbance of consciousness between patients with postoperative pulmonary infection and patients without postoperative pulmonary infection(P<0.05);there were no significant differences in gender,age,body mass index and type of interventional therapy between the two groups(P>0.05).logistic regression analysis showed that COPD,diabetes,invasive operation and disturbance of consciousness were the risk factors for pulmonary infection in AIS patients after interventional therapy(OR>1,P<0.05).Conclusion:The incidence of pulmonary infection of AIS patients after intervention is high,the main pathogenic bacteria are Gram negative bacteria such as Klebsiella pneumoniae,Pseu

关 键 词：急性缺血性脑卒中 血管内介入治疗 肺部感染 病原菌 糖尿病 意识障碍 

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]