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目的研究分析老年脑梗死(CI)患者发生肺部感染(NPI)临床特点及危险因素,为CI患者NPI防治提供依据。方法选取2013年4月-2014年4月收治的CI患者266例作为研究对象,根据患者是否发生NPI将其分为感染组25例及未感染组241例,分析老年CI患者NPI临床特点,并对老年CI患者NPI进行单因素和多因素分析。结果 266例CI患者中发生NPI25例,感染率为9.40%;对感染患者进行痰培养,检出病原菌以铜绿假单胞菌、肺炎克雷伯菌及大肠埃希菌为主,分别占28.2%、19.7%、16.3%;感染组的pH值、动脉血氧分压(PaO2)、肿瘤坏死因子α(TNF-α)及白细胞介素-6(IL-6)水平与未感染组比较,差异均有统计学意义(P<0.05);单因素分析结果显示,年龄、糖尿病、肌力Ⅱ级以下、意识障碍、慢性阻塞性肺疾病(COPD)及球麻痹与老年CI患者NPI的发生具有相关性(P<0.05);多因素logistic回归分析结果显示,年龄≥70岁、糖尿病、肌力Ⅱ级以下、意识障碍、COPD、球麻痹为老年CI患者NPI的独立危险因素。结论对于老年CI患者,在给予相应治疗的同时,应根据NPI的临床特点及危险因素,施以规范正确的预防措施,以降低NPI的发生率。
Objective To study the clinical characteristics and risk factors of pulmonary infection (NPI) in elderly patients with cerebral infarction (CI) and provide evidence for the prevention and treatment of NPI in CI patients. Methods A total of 266 patients with CI who were treated from April 2013 to April 2014 were selected as the study subjects. According to their NPI, the patients were divided into infection group (n = 25) and non-infection group (n = 241) Univariate and multivariate analysis of NPI in elderly CI patients. Results Among 266 CI patients, 25 cases of NPI occurred and the infection rate was 9.40%. The infected patients were sputum culture, the main pathogenic bacteria were Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli, accounting for 28.2% , 19.7% and 16.3% respectively. The difference of pH value, PaO2, TNF-α and IL-6 in infected group was significantly higher than that in non-infected group (P <0.05). Univariate analysis showed that age, diabetes mellitus, muscular strength grade Ⅱ, disturbance of consciousness, chronic obstructive pulmonary disease (COPD) and ball palsy were associated with the occurrence of NPI in elderly CI patients (P <0.05). Multivariate logistic regression analysis showed that age ≥ 70 years old, diabetes, muscular strength grade Ⅱ, disturbance of consciousness, COPD and ball paralysis were the independent risk factors for NPI in elderly patients with CI. Conclusions In the elderly patients with CI, the appropriate treatment should be given at the same time, should be based on the clinical features of NPI and risk factors, to regulate the correct preventive measures to reduce the incidence of NPI.