高血压脑出血术后并发肺部感染的影响因素分析

摘要

目的：对高血压脑出血（IC H ）患者术后并发肺部感染的临床特征和影响因素进行分析。方法选取183例高血压ICH患者作为研究对象，收集痰标本并进行细菌培养，观察并发肺部感染情况，收集患者的临床资料并应用Glasgow 昏迷评分（GCS评分）对其术后昏迷情况进行观察和评价，同时对患者并发肺部感染的危险因素进行分析。结果患者并发肺部感染的发生率为36.6％，感染患者的病死率为29.9％，单因素分析结果显示，年龄＞60岁、出血量＞100 mL、GCS 评分≤8分、长期吸烟、合并慢性呼吸系统疾病、合并糖尿病、有术前呕吐与误吸是与高血压IC H术后并发肺部感染相关的危险因素；在痰标本中检出的革兰阴性杆占72.2％，对美罗培南、头孢哌酮／舒巴坦的耐药率较低；革兰阳性球菌占24.5％，对万古霉素、利奈唑胺的耐药率较低；真菌占3.2％，对伊曲康唑的耐药率较低。结论高血压IC H患者术后合并肺部感染的发病率和病死率均较高，感染的病原菌以革兰阴性杆菌为主，年龄＞60岁、出血量＞100 mL、GCS评分≤8分、长期吸烟、合并慢性呼吸系统疾病、合并糖尿病、有术前呕吐与误吸是危险因素。%Objective To observe and analyze the clinical characteristics of patients with hypertensive intracerebral hemor-rhage (ICH) complicated with postoperative pulmonary infection and its influencing factors .Methods 183 cases of patients with hypertensive ICH were selected as the research objects.The sputum specimens of the patients were collected and bacterial culture was employed to observe the pulmonary infection rate.The general clinical data of the patients were collected and the Glasgow coma score (GCS score) was used to observe and evaluate the postoperative coma of the patients.The risk factors of the patients complicated with pulmonary infection were analyzed.Results The rate of the patients complicated with pulmonary infection was 36.6% and the mortality rate of infected patients was 29.9% . The single factor analysis showed that age >60 years old ,bleeding volume >100 mL ,GCS score≤8 ,long-term smoking ,complicated with chronic respiratory diseases ,compli-cated with diabetes mellitus ,preoperative vomiting and aspiration were the risk factors associated with postoperative pulmonary infection of patients with hypertensive ICH ;the gram negative rod detected in sputum specimens accounted for 72.2% and the resistance rates to meropenem ,Cefoperazone /Shubatan were low ;the gram positive cocci accounted for 24.5% and the resist-ance rates to vancomycin ,linezolid were low ;the fungi detected accounted for 3.2% and the resistance rate to itraconazole was lower. Conclusion The incidence and mortality of the patients with hypertensive ICH complicated with postoperative pulmona-ry infection are higher and most of the pathogens in the infection were gram negative bacilli.Age >60 years old ,bleeding vol-ume >100mL ,GCS score≤8 ,long-term smoking ,complications of chronic respiratory diseases ,complications with diabetes mel-litus ,preoperative vomiting and aspiration are the risk factors associated with the incidence.