大面积脑梗死患者卒中相关性肺炎菌群分布及其危险因素研究

摘要

目的 分析大面积脑梗死(MCI)患者卒中相关性肺炎(SAP)菌群分布及其危险因素.方法 选取2015-2016年上海市电力医院收治的MCI患者117例,根据住院期间SAP发生情况分为A组(发生SAP,n=29例)和B组(未发生SAP,n=88).SAP患者采用抗生素治疗前完成痰细菌培养、痰真菌培养;比较两组患者临床资料,而MCI患者SAP的危险因素分析采用多因素Logistic回归分析.结果 本组患者SAP发生率为24.78%;其中革兰阴性菌感染者14例(占48.28%),革兰阳性菌感染者7例(占24.14%),真菌感染者5例(占17.24%),混合感染者3例(占10.34%).两组患者性别、有无高血压、有无高脂血症比较,差异无统计学意义(P>0.05);两组患者年龄、有无糖尿病、有无慢性阻塞性肺疾病(COPD)、有无延髓麻痹、有无意识障碍、有无鼻饲支持、有无气管插管与切开及营养状况比较,差异有统计学意义(P<0.05).多因素Logistic回归分析结果显示,年龄〔OR=3.071,95%CI(1.480,6.855)〕、糖尿病〔OR=2.574,95%CI(1.388,12.037)〕、COPD〔OR=2.610,95%CI(1.632,19.375)〕、延髓麻痹〔OR=4.028,95%CI(2.061,28.361)〕、意识障碍〔OR=2.016,95%CI(1.351,10.064)〕、气管插管与切开〔OR=3.887,95%CI(3.796,51.836)〕是MCI患者SAP的独立危险因素(P<0.05).结论 MCI患者SAP致病菌以革兰阴性菌为主,且年龄、糖尿病、延髓麻痹、意识障碍及气管插管与切开是MCI患者SAP的危险因素,应引起临床重视.%Objective To analyze bacterial distribution and risk factors of stroke-associated pneumonia in patients with massive cerebral infarction.Methods A total of 117 patients with massive cerebral infarction were selected in Shanghai Electric Power Hospital from 2015 to 2016,and they were divided into A group(complicated with stroke-associated pneumonia,n=29)and B group(did not complicate with stroke-associated pneumonia,n=88)according to the incidence of stroke-associated pneumonia.Sputum bacteria culture and sputum fungus culture of patients complicated with stroke-associated pneumonia were completed before antibiotic therapy;clinical data was compared between the two groups,and risk factors of stroke-associated pneumonia in patients with massive cerebral infarction were analyzed by multivariate Logistic regression analysis.Results The incidence of stroke-associated pneumonia was 24.78%(29/117),including 14 cases with gram-negative bacteria infection(accounting for 48.28%),7 cases with gram-positive bacteria infection(accounting for 24.14%),5 cases with fungal infection(accounting for 17.24%),3 cases with mixed infection(accounting for 10.34%).No statistically significant differences of gender,with hypertension or not,with hyperlipidaemia or not was found between the two groups(P>0.05),while there were statistically significant differences of age,with diabetes or not,with COPD or not,with bulbar paralysis or not,with conscious disturbance or not,with nasogastric feeding support or not,with tracheal intubation and incision or not and nutritional status between the two groups(P<0.05).Multivariate Logistic regression analysis results showed that,age〔OR=3.071,95%CI(1.480,6.855)〕,diabetes〔OR=2.574,95%CI(1.388,12.037)〕,COPD〔OR=2.610,95%CI(1.632,19.375)〕,bulbar paralysis〔OR=4.028,95%CI(2.061,28.361)〕,conscious disturbance〔OR=2.016,95%CI(1.351,10.064)〕,tracheal intubation and incision〔OR=3.887,95%CI(3.796,51.836)〕were independent risk factors of stroke-associated pneumonia in patients with massive cerebral infarction(P<0.05).Conclusion Gram-negative bacteria is the major pathogenic bacterium in massive cerebral infarction patients complicated with stroke-associated pneumonia;age,diabetes,COPD,bulbar paralysis,conscious disturbance,tracheal intubation and incision are risk factors of stroke-associated pneumonia in patients with massive cerebral infarction,which should pay more attentions to.