| 马巧亚,时代音,胡春婷,刘 盼,巩付华.脑卒中并发肺炎患者的病原学特点及危险因素分析[J].,2019,19(22):4339-4343 |
| 脑卒中并发肺炎患者的病原学特点及危险因素分析 |
| A Study on the Pathogenic Characteristics and Risk Factors of Stroke Patients Complicated with Pneumonia |
| 投稿时间：2019-03-08 修订日期：2019-03-31 |
| DOI：10.13241/j.cnki.pmb.2019.22.030 |
| 中文关键词: 脑卒中并发肺炎 病原菌 耐药性 危险因素 |
| 英文关键词: Stroke associated pneumonia Pathogenic bacteria Drug resistance Risk factors |
| 基金项目:陕西省重点研发计划一般项目(2017SF-019)；2015年西安交通大学第二附属医院科研基金青年项目(YJ(QN)201531) |
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| 中文摘要: |
| 摘要 目的：探讨脑卒中并发肺炎(SAP)患者的病原菌分布、耐药性及其相关危险因素。方法：回顾性收集我院2016年1月-2017年12月神经科住院的160例SAP患者临床资料，并选择同期脑卒中不伴肺炎患者100例作为对照组。SAP患者入院第1、2天行痰培养实验及药敏实验，分析其病原菌特点、耐药性及SAP发生的相关危险因素。结果：160例患者痰液标本中，90例细菌培养阳性，阳性率56.25%。其中，革兰氏阴性菌61株(67.78%)，革兰氏阳性菌29株(32.22%)。SAP患者的病原菌主要是革兰氏阴性菌，革兰氏阴性菌耐药率较高的有氨苄西林、哌拉西林和氨苄西林/舒巴坦，革兰氏阳性菌耐药率较高的有克林霉素和头孢唑啉。单因素分析显示年龄、卒中类型、GCS评分、WBC高于10×109 /L、机械通气和吞咽困难均与SAP发生有关(P<0.05)。Logistics回归分析显示年龄>65岁、GCS评分≤ 8分、WBC高于10×109 /L、机械通气和吞咽困难均是SAP发生的独立危险因素。结论：SAP患者致病菌以革兰氏阴性菌为主，需多关注高龄、GCS评分较低、WBC水平较高、机械通气和吞咽困难的患者，以预防SAP的发生。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the distribution and drug resistance of pathogens in patients with stroke complicated with pneumonia (SAP) and analyze the related risk factors. Methods: The clinical data of 160 cases of patients with SAP admitted to our hospital from July 2016 to December 2017 were retrospectively reviewed. 100 cases of stroke patients without pneumonia were selected as the control group. The sputum culture anddrug sensitivity test were conducted in the SAP group on day 1 and 2 after admission. And the characteristics of pathogens, drug resistance and risk factors associated with SAP were analyzed. Results: Among the 160 patients, 90 cases of sputum samples were positive for bacterial culture, and the positive rate was 56.25%. Among them, gram-negative bacteria were 61, accounting for 67.78%, while gram-positive bacteria were 29, accounting for 32.22%. The main pathogens of SAP patients were Gram-negative bacteria. Gram-negative bacteria with higher resistance rates are ampicillin, piperacillin and ampicillin/sulbactam. Gram-positive bacteria have higher resistance rates, such as clindamycin and cefazolin. Univariate analysis showed that age, stroke type, GCS score, WBC higher than 10×109/L, mechanical ventilation and dysphagia were associated with SAP (P<0.05). Logistics regression analysis showed that age >65 years, GCS score≤8 points, WBC higher than 10×109/L, mechanical ventilation and dysphagia were independent risk factors for SAP. Conclusion: Gram-negative bacteria are the main pathogens in SAP patients. It is necessary to pay more attention to the elderly, patients with lower GCS scores, higher WBC levels, mechanical ventilation and dysphagia ,which can prevent SAP. |
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