腦卒中相關(guān)性肺炎多重耐藥性感染危險(xiǎn)因素及控制措施

羅婭 李中秋 曾梅芳

[摘要] 目的 了解腦卒中相關(guān)性肺炎多重耐藥性感染的相關(guān)危險(xiǎn)因素，并依據(jù)相關(guān)危險(xiǎn)采取相關(guān)控制措施。 方法 選擇2013年8月～2014年9月在湖南師范大學(xué)附屬湘南醫(yī)院住院治療的急性腦卒中患者540例，對(duì)于腦卒中相關(guān)性肺炎（SAP）患者采集晨痰進(jìn)行送檢，了解其多重耐藥性情況。利用單因素和多因素Logistic回歸分析法對(duì)導(dǎo)致患者發(fā)生醫(yī)院感染的相關(guān)危險(xiǎn)因素進(jìn)行分析。 結(jié)果 540例急性腦卒中患者，發(fā)生相關(guān)性肺炎的患者共89例，感染率為16.46%；89例SAP患者共分離出病原菌167株，其中多重耐藥菌123株，革蘭陰性菌占68.29%，以銅綠假單胞菌、肺炎克雷伯桿菌及鮑曼不動(dòng)桿菌為主。革蘭陽(yáng)性菌占31.71%，以溶血性葡萄球菌、金黃色葡萄球菌為主；結(jié)果顯示年齡≥50歲，住院時(shí)間≥30 d，合并糖尿病、意識(shí)障礙、低蛋白血癥、機(jī)械通氣及留置鼻飼管等相關(guān)侵入性操作是SAP多重耐藥性發(fā)生的獨(dú)立危險(xiǎn)因素（P < 0.05）。 結(jié)論 SAP的發(fā)病率在臨床上相對(duì)較高，且發(fā)生SAP的患者病原菌分布主要以多重耐藥菌為主，因此詳細(xì)了解引起SAP多重耐藥性的病原菌分布情況及發(fā)生風(fēng)險(xiǎn)的危險(xiǎn)因素，采用針對(duì)性的預(yù)防措施有著重要意義。

[關(guān)鍵詞] 腦卒中；相關(guān)性肺炎；多重耐藥菌；危險(xiǎn)因素

[中圖分類號(hào)] R743 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1673-7210（2018）03（b）-0108-05

Risk factors and control measures of multidrug resistance in stroke - related pneumonia

LUO Ya1，2 LI Zhongqiu1 ZENG Meifang2

1.Department of Neurology， 169th Hospital of PLA Hu′nan Normal University Affiliated Xiangnan Hospital， Hu′nan Province， Hengyang 4210022， China； 2.Health Economics Office， 169th Hospital of PLA Hu′nan Normal University Affiliated Xiangnan Hospital， Hu′nan Province， Hengyang 4210022， China

[Abstract] Objective To understand the risk factors associated with multiple drug-resistant infections in stroke-associated pneumonia and to take relevant control measures based on the relevant risks. Methods A total of 540 acute stroke patients hospitalized from August 2013 to September 2014 in Hunan Normal University Affiliated Xiangnan Hospital were selected. Morning sputum was collected from patients with stroke-associated pneumonia for multi-drug resistance. Univariate and multivariate logistic analyzes were used to analyze the risk factors that led to hospital-acquired nosocomial infections. Results Among the 540 patients with acute stroke， 89 cases were associated with pneu monia and the infection rate was 16.46%. A total of 167 pathogenic bacteria were isolated from 89 stroke-associated pneumonia （SAP） patients， of which 123 were multi-drug resistant bacteria， and the gram-negative bacteria accounting for 68.29% with pseudomonas aeruginosa， klebsiella pneumoniae and acinetobacter baumannii. Gram-positive bacteria accounting for 31.71% with staphylococcus haemolyticus and staphylococcus aureus. The results showed that patients aged≥ 50 years， hospital stay≥ 30 d， with diabetes， disturbance of consciousness， hypoproteinemia， mechanical ventilation and indwelling nasogastric tube and other related invasive procedures were independent risk factors for SAP multidrug resistance （P < 0.05）. Conclusion SAP incidence is clinically relatively high， and the incidence of pneumonia associated with the distribution of pathogens are mainly multi-resistant bacteria. Therefore， it is of great significance to use targeted preventive measures to understand the distribution of pathogenic bacteria and the risk factors that cause the multiple drug resistance of SAP.

[Key words] Stroke； Related pneumonia； Multiple drug resistance； Risk factors

腦卒中相關(guān)性肺炎（stroke-associated pneumonia，SAP）是指腦卒中患者急性期及后遺癥期并發(fā)的肺感染。文獻(xiàn)報(bào)道，SAP是導(dǎo)致腦卒中患者病情惡化、預(yù)后不良及死亡的重要原因。SAP不僅嚴(yán)重影響患者預(yù)后，而且延長(zhǎng)住院時(shí)間，增加住院費(fèi)用，給患者和患者家屬帶來(lái)了嚴(yán)重的經(jīng)濟(jì)負(fù)擔(dān)[1-2]。研究證實(shí)，腦卒中有著發(fā)病率高、復(fù)發(fā)率高、致殘率高及死亡率高的特點(diǎn)。我國(guó)每年新發(fā)卒中病例超過(guò)200萬(wàn)，其中出血性卒中約20%，缺血性卒中約80%，死亡病例每年超過(guò)150萬(wàn)，死亡率約150/10萬(wàn)人[3-4]。……