摘要
目的总结卒中相关性肺炎(stroke associated pneumonia, SAP)的临床特点,并分析SAP发生的危险因素。方法选取我院2018年1月—2019年12月收治的急性脑卒中312例,所有患者根据入院1周内是否发生SAP分为SAP组69例和非SAP组243例。分析SAP临床特点及发生的危险因素。结果 SAP组病原菌以金黄色葡萄球菌、肺炎克雷伯杆菌、铜绿假单胞菌为主;以男性、高龄(≥65岁)为主,>50%患者有糖尿病史、低蛋白血症史并伴有意识障碍、吞咽困难,大部分患者有抑酸剂应用史。年龄≥65岁、吸烟史、糖尿病史、低蛋白血症、美国国立卫生院卒中量表(NIHSS)评分≥13分、意识障碍、吞咽困难、留置胃管、深静脉置管、机械通气、抑酸剂应用史是SAP发生的独立危险因素(P<0.01)。结论 SAP患者主要致病菌为铜绿假单胞菌、肺炎克雷伯杆菌和金黄色葡萄球菌;发病危险因素复杂,医务人员应及早对急性脑卒中患者进行评估,及早发现SAP发生危险因素,并采取积极的针对性防治措施以改善患者预后。
Objective To summarize the clinical features of stroke associated pneumonia(SAP)and to analyze the risk factors of SAP.Methods A total of 312 patients with acute stroke admitted to our hospital from January 2018 to December 2019 were selected as the research subjects.All patients were divided into SAP group(n=69)and non-SAP group(n=243)according to presence or absence of SAP within one week after admission.The clinical characteristics and risk factors of SAP were analyzed.Results Staphylococcus aureus,Klebsiella pneumoniae and Pseudomonas aeruginosa were the main pathogens in SAP group,most patients were elderly males(≥65 years).Over 50%of the patients had a history of diabetes mellitus,hypoproteinemia,accompanied by disturbance of consciousness and dysphagia.Most of the patients had history of acid inhibitors.Age≥65 years,smoking history,diabetes history,hypoproteinemia,National Institute of Health stroke scale(NIHSS)score≥13,disturbance of consciousness,dysphagia,indwelling gastric tube,deep vein catheterization,mechanical ventilation,and history of acid inhibitors were independent risk factors for SAP(P<0.01).Conclusion The main pathogenic bacteria of SAP patients are Pseudomonas aeruginosa,Klebsiella pneumoniae and Staphylococcus aureus,and the risk factors of SAP are complex.Therefore,medical staff should evaluate the patients with acute stroke and find out the risk factors of SAP as early as possible,and take active and targeted prevention and control measures to improve the prognosis of patients.
作者
任向利
任向杰
白玉
刘肇伟
马雪静
REN Xiang-li;REN Xiang-jie;BAI Yu;LIU Zhao-wei;MA Xue-jing(Department of Neurology,the Fourth People's Hospital of Langfang,Langfang,Hebei 065700,China;Department of Imaging,the Fourth People's Hospital of Langfang,Langfang,Hebei 065700,China)
出处
《解放军医药杂志》
CAS
2021年第1期44-48,共5页
Medical & Pharmaceutical Journal of Chinese People’s Liberation Army
基金
河北省医学科学研究重点课题计划项目(20201300)。
