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目的探讨急性脑卒中患者肺部感染的病原菌特点及危险因素,以期为控制及降低急性脑卒中患者肺部感染的发生提供参考依据。方法回顾性分析2011年1月-2012年12月208例急性脑卒中患者临床资料,分析肺部感染病原菌特点及危险因素,采取SPSS16.0进行统计分析,计数资料采取χ2检验,多因素分析采取非条件logistic回归分析。结果发生肺部感染的52例肺部感染发生率为25.00%,送检痰液标本培养阳性率为80.77%,检出病原菌共50株,其中革兰阴性菌36株占72.00%,革兰阳性菌12株占24.00%,真菌2株占4.00%,革兰阴性菌主要为肺炎克雷伯菌、鲍氏不动杆菌、铜绿假单胞菌、阴沟肠杆菌,革兰阳性菌主要为金黄色葡萄球菌、表皮葡萄球菌、溶血葡萄球菌;单因素结果分析显示,年龄、糖尿病、侵入性操作、意识障碍、低蛋白血症、住院时间是与肺部感染发生有关的单危险因素(P<0.01),非条件logistic回归分析结果显示,年龄大、有侵入性操作、合并糖尿病、有意识障碍、合并低蛋白血症、住院时间长是发生肺部感染的独立危险因素(P<0.05)。结论急性脑卒中患者容易发生肺部感染,感染病原菌以革兰阴性菌为主,患者年龄大、有侵入性操作、合并糖尿病、有意识障碍、合并低蛋白血症、住院时间长是引起患者发生肺部感染的独立危险因素。
Objective To investigate the characteristics and risk factors of pulmonary infection in patients with acute stroke in order to provide reference for controlling and reducing the incidence of pulmonary infection in patients with acute stroke. Methods The clinical data of 208 acute stroke patients from January 2011 to December 2012 were retrospectively analyzed. The characteristics and risk factors of pulmonary pathogens were analyzed. Statistical analysis was performed by using SPSS16.0. The count data were analyzed by χ2 test and multivariate analysis Non-conditional logistic regression analysis. Results The incidence rate of pulmonary infection in 52 cases with pulmonary infection was 25.00%. The positive rate of sputum specimens in culture was 80.77%. There were 50 pathogenic bacteria detected, of which 36 strains of Gram-negative bacteria accounted for 72.00%, Gram-positive 12 strains accounted for 24.00%, 2 strains accounted for 4.00%, Gram-negative bacteria mainly Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter cloacae, Gram-positive bacteria mainly golden yellow Staphylococcus aureus, Staphylococcus epidermidis and Staphylococcus haemolyticus. Univariate analysis showed that age, diabetes, invasive procedures, disturbance of consciousness, hypoalbuminemia, and hospital stay were the single risk factors associated with pulmonary infection (P <0.01 ). The unconditional logistic regression analysis showed that older age, invasive procedure, combined with diabetes mellitus, disturbance of consciousness, hypoproteinemia and long hospital stay were independent risk factors of pulmonary infection (P <0.05). Conclusions Acute stroke patients are susceptible to pulmonary infection. Gram-negative bacteria are the main pathogens in patients with acute stroke. The patients are older, have invasive procedures, have diabetes mellitus, have impaired consciousness, have hypoproteinemia, and have a long hospital stay to cause pulmonary development Department of infection of the independent risk factors.