摘要
目的探讨ICU中急性脑卒中患者并发卒中相关性肺炎(SAP)的病原学特点与危险因素。方法选取2015年4月至2017年10月收治的121例急性脑卒中患者,对其资料进行回顾性分析,观察SAP病原学特点,使用多因素logistic回归法分析其危险因素。结果 121例急性脑卒中患者中有59例发生SAP(48.76%),其中早发性肺炎(EOP)40例(67.80%),晚发性肺炎(LOP)19例(32.20%)。痰液培养出菌株包括10种细菌与2种真菌,其中革兰阴性杆菌31株(63.27%),革兰阳性球菌10株(20.41%),真菌8株(16.33%)。logistic回归分析显示,年龄≥65岁,有吞咽困难、意识障碍、糖尿病、吸烟史、鼻饲治疗、预防性使用抗生素或胃黏膜保护剂是SAP的独立危险因素(均P<0.05)。鼻饲治疗的患者患EOP的可能性更大、预防性使用抗生素的患者患LOP的可能性更大。结论SAP患者中,EOP比例高于LOP,革兰阴性菌是其主要致病菌。年龄≥65岁、意识障碍、糖尿病、吞咽障碍、吸烟史、鼻饲治疗、预防性使用抗生素或胃黏膜保护剂是SAP的危险因素,根据患者病原学特点制定针对性的防治策略意义重大。
Objective To investigate the pathogen distribution and risk factors of stroke-associated pneumonia(SAP)in intensive care unit(ICU).Methods One hundred and twenty one patients with acute stroke admitted in ICU of Zhenhai District People's Hospital from April 2015 to October 2017 were enrolled in the study.The sputum bacterial culture was performed in patients complicated with pneumonia and the risk factors of SAP were analyzed by multivariate logistic regression,and the influence of SAP on mortality was also analyzed.Results In 121 patients with acute stroke,59 had SAP accounting for 48.76%.Among them,there were 40 cases of early-onset pneumonia(EOP)(67.80%)and 19 cases of late-onset pneumonia(LOP)(32.20%).Total 49 strains of bacteria were detected in sputum culture,including 10 kinds of bacteria and 2 kinds of fungi.31 strains were gram negative bacilli(63.27%),10 were grampositive cocci(20.41%),and 8 were fungi(16.33%).Logistic regression analysis showed that≥65 years of age,difficulty in swallowing,consciousness disorders,diabetes,smoking history,nasal feeding,administration of prophylactic antibiotics and gastric mucosal protective agent were independent risk factors of SAP(P<0.05).The mortality rate of SAP patients was significantly higher than that of non-SAP patients(P<0.01).Patients treated with nasal feeding were more likely to suffer from EOP and those treated with prophylactic antibiotics were more likely to suffer from LOP.Conclusion The incidence of SAP in ICU is high,which would increase the mortality of stroke patients in ICU,it is necessary to develop specific prevention strategies for SAP based on its risk factors.
作者
项美玲
谭九根
谢建平
王美华
XIANG Meiling;TAN Jiugen;XIE Jianping(Intensive Care Unit,Zhenhai District People’s Hospital,Ningbo 315202,China)
出处
《浙江医学》
CAS
2019年第8期772-775,779,共5页
Zhejiang Medical Journal
