| 樊云峰,张增瑞,宋 英,齐少明,廉 钰.脑卒中昏迷患者气管切开后并发肺部感染的病原菌分布及预防对策[J].,2017,17(27):5348-5353 |
| 脑卒中昏迷患者气管切开后并发肺部感染的病原菌分布及预防对策 |
| Pathogenic Bacteria Distribution and Preventive Measures of Pulmonary Infection after Tracheotomy in Patients with Stroke Coma |
| 投稿时间：2017-05-16 修订日期：2017-06-12 |
| DOI：10.13241/j.cnki.pmb.2017.27.038 |
| 中文关键词: 脑卒中 昏迷 气管切开 肺部感染 病原菌 危险因素 |
| 英文关键词: Stroke Coma Tracheotomy Pulmonary infection Pathogenic bacteria Risk factors |
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| 中文摘要: |
| 摘要 目的：探讨脑卒中昏迷患者气管切开后并发肺部感染的病原菌分布及危险因素，并提出预防措施。方法：回顾性分析2016年1月至2017年2月我院收治的脑卒中昏迷患者96例，分析脑卒中昏迷患者肺部感染发生率及病原菌分布情况，同时采用单因素和多因素logistic回归分析肺部感染的危险因素，从而提出相应的预防措施。结果：96例脑卒中昏迷患者气管切开术后肺部感染的发生率为48.96%（47/96）；共分离培养病原菌104株，包括革兰阴性菌69株（66.35%）、革兰阳性菌20株（19.23%）和真菌15株（14.42%）；单因素分析结果显示，脑卒中昏迷患者气管切开术后肺部感染与年龄、基础疾病、气管切开时间、卧床时间、使用广谱抗菌药物、吸烟史、人工气道、吸痰次数及雾化吸入次数密切相关（P<0.05），而与患者性别、体重、脑卒中类型无关（P>0.05）；多因素logistic回归分析结果显示，年龄45岁、合并患有基础疾病、气管切开时间5 d、使用广谱抗菌药物、吸烟史及建立人工气道均为脑卒中昏迷患者气管切开术后肺部感染的危险因素（P<0.05），ROC分析结果为：气管切开时间的临界点（阈值C）是4.3天，其灵敏度和特异度将分别为0.851和0.918。结论：脑卒中昏迷患者气管切开后并发肺部感染的病原菌以革兰阴性菌为主，年龄 45岁、合并患有基础疾病、气管切开时间5 d、使用广谱抗菌药物、吸烟史及建立人工气道能够导致脑卒中昏迷患者气管切开术后发生肺部感染，并且气管切开时间超过4.3天，脑卒中昏迷患者肺部感染的风险将大大增加，应根据病原学特征及其危险因素，采取针对性措施，降低肺部感染的发病风险。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the pathogenic bacteria distribution and risk factors of pulmonary infection after tracheotomy in patients with stroke coma, and to put forward preventive measures. Methods: 96 patients with stroke coma from January 2016 to February 2017 in our hospital were retrospectively analyzed.The incidence of pulmonary infection and distribution of pathogenic bacteria of patients with stroke coma were analyzed. At the same time, the risk factors of pulmonary infection were analyzed by single factor and multiple factors logistic regression analysis, and corresponding preventive measures were put forward. Results: The incidence of pul- monary infection after tracheotomy in 96 patients with stroke coma was 48.96% (47/96). A total of 104 pathogens were isolated and cul- tured, including gram negative bacteria 69 strains(66.35%), gram positive bacteria 20 strains(19.23%) and fungus 15 strains(14.42%). Single factor regression analysis results showed that pulmonary infection after tracheotomy in patients with stroke coma was closely re- lated with age, basic diseases, time of tracheotomy, and bed time, use of broad-spectrum antibiotics, smoking history, artificial airway, times of sputum suction and inhalation(P<0.05), and it was not related to the patient's gender, weight, stroke type (P>0.05). Multivariate logistic regression analysis showed that age 45 years old, complicated with basic disease, time of tracheotomy 5 d, use of broad-spectrum antibiotics, smoking history and the establishment of artificial airway were risk factors of pulmonary infection after tracheotomy in pa- tients with stroke coma (P<0.05). ROC analysis results showed that the critical point (threshold C) of tracheotomy time was 4.3 days, and the sensitivity and specificity were 0.851 and 0.918 respectively. Conclusion: The main pathogenic bacteria of pulmonary infection after tracheotomy in patients with stroke coma is gram-negative bacteria, age 45 years old, complicated with basic disease, time of tracheoto- my 5d, use of broad-spectrum antibiotics, smoking history and the establishment of artificial airway can lead to pulmonary infection after tracheotomy in patients with stroke coma, and the risk of pulmonary infection in patients with stroke coma will increase considerably af- ter the time of tracheotomy for more than 4.3 days. Targeted measures should be taken to reduce the risk of pulmonary infection accord- ing to pathogenic features and risk factors. |
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