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目的探讨重型缺血性卒中发生肺部感染患者的病原菌分布及其诊断治疗方法,为重型缺血性卒中患者预防、诊治及控制肺部感染提供临床依据。方法选取医院2013年1月-2015年1月收治的158例发生肺部感染的重型缺血性卒中患者为观察组,另选同期100例无肺部感染的重型缺血性卒中患者为对照组,检查所有患者(1-3)-β-D-葡聚糖、血清降钙素原(PCT)和超敏C-反应蛋白(hs-CRP)水平,并对发生肺部感染患者进行痰液培养。结果 158例发生肺部感染重型缺血性卒中患者痰液标本中培养出病原菌182株,其中革兰阳性菌78株、革兰阴性菌104株,分别占42.87%和57.13%;单菌种感染134例,多菌种混合感染24例,分别占84.81%和15.19%;158例肺部感染患者治疗总有效率为98.10%;观察组(1-3)-β-D-葡聚糖、PCT和hs-CRP水平显著高于对照组,差异有统计学意义(P<0.01);治疗30d后,观察组和对照组综合治疗总有效率分别为90.51%和93.00%,两组比较差异无统计学意义。结论重型缺血性卒中并发肺部感染患者病原菌中,革兰阴性菌检出率高于革兰阳性菌,检测(1-3)-β-D-葡聚糖、PCT和hs-CRP水平对于诊断肺部感染具有重要意义。
Objective To investigate the distribution of pathogenic bacteria in patients with pulmonary infection due to severe ischemic stroke and its diagnosis and treatment methods to provide a clinical basis for the prevention, diagnosis and treatment of pulmonary infection in patients with severe ischemic stroke. Methods A total of 158 patients with severe ischemic stroke who had pulmonary infection admitted to the hospital from January 2013 to January 2015 were selected as the observation group and another 100 patients with severe ischemic stroke without pulmonary infection were selected as the control group , All patients (1-3) -β-D-glucan, serum procalcitonin (PCT), and hs-CRP levels were examined for sputum production in patients with pulmonary infections to cultivate. Results A total of 182 pathogenic bacteria were isolated from sputum of 158 cases of patients with severe acute ischemic stroke. Among them, 78 were Gram-positive bacteria and 104 were gram-negative bacteria, accounting for 42.87% and 57.13% respectively; 134 cases, mixed infection of multiple bacteria in 24 cases, accounting for 84.81% and 15.19% respectively; the total effective rate was 98.10% in 158 cases of pulmonary infection; the observation group (1-3) -β-D-glucan, PCT And hs-CRP levels were significantly higher than those in the control group (P <0.01). After 30 days of treatment, the total effective rates in the observation group and the control group were 90.51% and 93.00% respectively, with no statistical difference between the two groups Significance of learning. Conclusion The detection rate of Gram-negative bacteria in Gram-negative bacteria is higher than that in Gram-positive bacteria in patients with severe ischemic stroke and pulmonary infection. The levels of (1-3) -β-D-glucan, PCT and hs-CRP Diagnosis of lung infection is of great significance.