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目的探讨急性重症脑卒中患者住院期间感染性并发症的临床特点。方法对54例符合入选标准的急性重症脑出血或脑梗死患者的临床资料进行系统回顾,分析入组患者各种感染并发症的发生率、病原学检查结果以及其他一般临床资料,并采用Logistic回归分析与感染并发症发生相关的各种因素。结果患者住院第2周的总感染并发症发生率较第1周时显著增高(39%vs52%,P<0.05),主要以肺部和尿路感染(41%)为主,部分患者还并发败血症(9%);感染病原体以革兰氏阴性(G-)杆菌和革兰氏阳性(G+)球菌感染为主,其次为真菌感染;药敏试验提示细菌对头孢类、万古霉素、亚胺培南和喹诺酮类比较敏感。感染并发症的发生与患者住院时间、营养不良发生率、NIHSS评分、GCS昏迷量表评分、Barthel指数ADL评分密切相关(r分别为5.62、4.39、8.68、6.26和4.34;均P<0.05)。结论急性重症卒中患者住院期间感染并发症发生率高,严重影响患者的预后,其发生与患者住院时间、营养不良、神经功能缺损以及意识障碍程度密切相关。
Objective To investigate the clinical features of infectious complications in hospitalized patients with acute severe stroke. Methods The clinical data of 54 patients with acute severe intracerebral hemorrhage or cerebral infarction who met the inclusion criteria were systematically reviewed. The incidence of various infectious complications, the results of etiological examination and other general clinical data were analyzed. Logistic regression Analysis of various factors associated with the occurrence of infection complications. Results The incidence of infectious complications in the second week of hospitalization was significantly higher than that in the first week (39% vs52%, P <0.05), mainly in the lungs and urinary tract infections (41%), and some patients also complicated Sepsis (9%). Infectious pathogens were predominantly Gram-negative and Gram-positive (G +) infections, followed by fungal infections. Susceptibility tests suggested that the bacterial infection of cephalosporins, vancomycin, Amines and quinolones are more sensitive. Infection complications were closely related to hospital stay time, malnutrition incidence, NIHSS score, GCS coma scale score and Barthel index ADL score (r = 5.62,4.39,8.68,6.26 and 4.34, respectively; all P <0.05). Conclusion The incidence of infection complications during hospitalization in acute severe stroke patients seriously affects the prognosis of patients, and its occurrence is closely related to the length of hospital stay, malnutrition, neurological deficits and disturbance of consciousness.