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目的调查卒中相关性肺炎(HAP)主要易发因素及预防对策。方法对漯河市第二人民医院近几年住院的2136例脑卒中患者的临床资料作回顾性分析。结果共发生医院获得性肺炎256例,感染率11.98%。分析发现卒中相关性肺炎的危险因素为高年龄、意识不清、吞咽困难、侵袭性医源性操作、预防性应用抗生素、应用抑酸药物以及应用糖皮质激素。197例(去除未做痰培养或痰培养阴性的病例)检出病原菌,共分离出致病菌216株,其中126株革兰氏阴性杆菌,占58.33%,72株革兰氏阳性菌,占33.33%,其中肺炎克雷伯氏菌、铜绿假单胞菌、大肠埃希菌、金黄色葡萄球菌是卒中相关性肺炎的主要病原菌。药敏试验发现,肺炎克雷伯氏菌、大肠埃希菌、铜绿假单胞菌、金黄色葡萄球菌等对多种抗生素交叉耐药,对亚胺培南、美罗培南、万古霉素耐药率最低。结论脑卒中患者卒中相关性肺炎发病率较高,而且多种因素相互作用导致卒中相关性肺炎的发生,根据卒中相关性肺炎致病特点,采取针对性的药物选择。同时加强对医院感染的监控,根据主要危险因素采取有效的预防控制措施是预防卒中相关性肺炎的关键所在。
Objective To investigate the main risk factors of stroke-associated pneumonia (HAP) and the preventive measures. Methods The clinical data of 2136 stroke patients admitted to the Second People’s Hospital of Luohe City in recent years were retrospectively analyzed. Results A total of 256 cases of hospital acquired pneumonia occurred, the infection rate was 11.98%. The risk factors for stroke-associated pneumonia were high age, confusion, dysphagia, invasive medical operations, prophylactic antibiotics, use of acid-suppressing drugs, and glucocorticoid use. A total of 216 pathogenic bacteria were isolated from 197 patients (excluding sputum culture or sputum culture negative), of which 126 strains were Gram-negative bacilli (58.33%) and 72 strains were Gram-positive bacteria 33.33%, of which Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus is the main pathogen of stroke-associated pneumonia. Drug sensitivity test found that Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus and other antibiotics cross-resistant to imipenem, meropenem, vancomycin-resistant The lowest rate. Conclusion The incidence of stroke-associated pneumonia in stroke patients is high, and the interaction of various factors lead to the occurrence of stroke-associated pneumonia. According to the pathogenic characteristics of stroke-associated pneumonia, targeted drug selection is adopted. At the same time, strengthening surveillance on nosocomial infections and taking effective prevention and control measures according to the major risk factors are the key to preventing stroke-associated pneumonia.