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目的探讨自发性脑出血患者医院感染病原菌及危险因素分析,为临床诊断治疗提供参考。方法回顾性分析2012年5月-2014年2月接受诊治的817例自发性脑出血患者临床资料,统计医院感染率及感染部位分布,并分析性别、年龄、卒中量表(NIHSS)评分、格拉斯哥昏迷量表(GCS)评分、吸烟史及糖尿病史等与发生医院感染的关系。结果 817例自发性脑出血患者中发生医院感染127例,医院感染率为15.54%;感染部位以呼吸道为主,占58.27%,其次为胃肠道和泌尿道感染,分别占16.54%和13.38%;共分离出病原菌127株,其中革兰阴性菌89株占70.08%,以肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌、阴沟肠杆菌、产气肠杆菌为主,革兰阳性菌38株占29.92%,以金黄色葡萄球菌、粪肠球菌、凝固酶阴性葡萄球菌、屎肠球菌为主;年龄≥65岁、NIHSS评分≥10分、GCS评分<8分、有糖尿病史、有吸烟史与自发性脑出血患者发生医院感染具有相关性(P<0.05)。结论自发性脑出血患者医院感染病原菌以革兰阴性菌为主,医院感染因素包括年龄、NIHSS评分、GCS评分、有无吸烟史、有无糖尿病史等,且病死率较高,临床应对其引起高度重视。
Objective To investigate the pathogenic bacteria and risk factors of nosocomial infection in patients with idiopathic cerebral hemorrhage and provide reference for clinical diagnosis and treatment. Methods The clinical data of 817 patients with spontaneous intracerebral hemorrhage admitted to our hospital from May 2012 to February 2014 were retrospectively analyzed. The prevalence of nosocomial infection and the distribution of infection sites were statistically analyzed. The gender, age, stroke scale (NIHSS) score, Coma Scale (GCS) score, smoking history and diabetes history and the occurrence of nosocomial infections. Results Among the 817 patients with spontaneous intracerebral hemorrhage, nosocomial infection occurred in 127 cases and the hospital infection rate was 15.54%. The main infection area was respiratory tract, accounting for 58.27%, followed by gastrointestinal and urinary tract infections, accounting for 16.54% and 13.38% respectively. ; 127 strains of pathogens were isolated, of which 89 strains of Gram-negative bacteria accounted for 70.08%, with Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, Enterobacter cloacae, Enterobacter aerogenes, Gram Staphylococcus aureus, Enterococcus faecalis, coagulase-negative Staphylococcus aureus and Enterococcus faecium were the main pathogens of 38 strains of positive bacteria. Staphylococcus aureus, Enterococcus faecalis and Staphylococcus aureus were the main pathogenic bacteria. NIHSS score ≥10, NIHSS score <10, GCS score <8, There was a correlation between smoking history and nosocomial infection in patients with spontaneous cerebral hemorrhage (P <0.05). CONCLUSIONS: Gram-negative bacteria are the main pathogenic nosocomial infections in patients with spontaneous intracerebral hemorrhage. The factors affecting the hospital infection include age, NIHSS score, GCS score, history of smoking or no history of diabetes mellitus, with high mortality and clinical response highly valued.