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目的分析老年脑卒中并吸入性肺炎(AP)患者的病原菌分布及危险因素。方法选取2009年3月—2012年5月哈尔滨二四二医院收治的老年脑卒中患者737例,其中合并AP者58例,未合并AP者679例。分析58例并AP患者的病原菌分布及其危险因素。结果 58例老年脑卒中并AP患者共分离出93株病原菌,其中革兰阳性菌27株(29.0%);革兰阴性菌66株(71.0%)。年龄>70岁〔OR=1.897,95%CI(0.413,2.052)〕、意识障碍〔OR=1.676,95%CI(0.311,1.792)〕、侵袭性操作〔OR=1.387,95%CI(0.383,1.975)〕、吞咽困难〔OR=1.433,95%CI(1.407,4.452)〕及体位不当〔OR=1.994,95%CI(0.873,2.017)〕是老年脑卒中患者并发AP的独立危险因素(P<0.05)。结论老年脑卒中并AP患者的病原菌以革兰阴性菌为主,临床医生卧位、意识障碍、有侵袭性操作及吞咽困难的老年脑卒中患者应加强干预护理,以降低患者病死率。
Objective To analyze the distribution and risk factors of pathogenic bacteria in elderly patients with stroke and aspiration pneumonia (AP). Methods A total of 737 elderly stroke patients admitted from February 2009 to February 2012 in Harbin Hospital were included. Among them, 58 cases were complicated by AP, and 679 were not complicated by AP. 58 patients with pathogenic bacteria and AP distribution and risk factors. Results A total of 93 pathogenic bacteria were isolated from 58 senile patients with stroke and AP. Among them, 27 (29.0%) were gram-positive bacteria and 66 (71.0%) were gram-negative bacteria. Age> 70 years (OR = 1.897, 95% CI: 0.413, 2.052), disturbance of consciousness (OR = 1.676, 95% CI: 0.311, 1.975), dysphagia 〔OR = 1.433, 95% CI (1.407, 4.442)〕 and improper body position (OR = 1.994, 95% CI 0.873, 2.017) were independent risk factors for AP in elderly stroke patients (P <0.05). Conclusions Gram-negative bacteria are the main pathogenic bacteria in elderly stroke and AP patients. Intervention nursing should be strengthened in elderly stroke patients with clinicians in supine position, unconsciousness, aggressive operation and dysphagia to reduce the case fatality rate.