急性脑卒中患者并发重症肺炎的危险因素及病原菌分析(1)
[摘要] 目的 探讨急性脑卒中患者并发重症肺炎的危险因素及病原菌分布特征。 方法 回顾性分析2016年1月～2019年5月广东省佛山市中医院治疗的431例急性腦卒中患者，根据是否合并重症肺炎分为合并重症肺炎组(53例)及不合并重症肺炎组(378例)。分析急性脑卒中并发重症肺炎的危险因素，患者感染病原菌类型及药敏结果。 结果 两组患者年龄、住院天数、格拉斯哥昏迷量表(GCS)评分、美国国立卫生研究院卒中量表(NIHSS)评分、侵入性操作、慢性阻塞性肺疾病(COPD)及糖尿病比较，差异有统计意义(P < 0.05)。logistic回归分析显示，年龄(OR = 1.131)、GCS评分(OR = 0.663)、NIHSS评分(OR = 2.467)、有侵入性操作(OR = 16.890)是脑卒中并发重症肺炎的影响因素(P < 0.05)。431例急性脑卒中患者中，53例继发重症肺炎，感染率为12.3%，培养出病原菌38株，其中革兰阴性菌28株(73.7%)，革兰阳性菌8株(21.1%)，真菌2株(5.2%)。革兰阴性菌排名前3位分别是铜绿假单胞菌、鲍氏不动杆菌、大肠埃希菌。革兰阳性菌以金黄色葡萄球菌为主，真菌为白假丝酵母菌。铜绿假单胞菌、鲍氏不动杆菌、大肠埃希菌及肺炎克雷伯菌对头孢唑林、头孢曲松、环丙沙星、左氧氟沙星和庆大霉素有较高耐药率(耐药率>50%);对碳青酶烯类抗生素美罗培南和亚胺培南，喹诺酮类的环丙沙星和左氧氟沙星较为敏感(耐药率<20%)。 结论 在急性脑卒中患者中，要充分评估患者的基础疾病，采取多种积极的防治措施。在病原菌方面，急性脑梗死继发重症肺炎中以革兰阴性菌为主，在早期抗生素的选择方面应予以重视，做到避免滥用抗生素，减少耐药菌株的出现。
[关键词] 急性脑卒中;重症肺炎;病原菌;危险因素
[中图分类号] R563.1 [文献标识码] A [文章编号] 1673-7210(2020)07(a)-0101-04
[Abstract] Objective To investigate the risk factors and pathogenic bacteria distribution in patients with acute stroke complicated with severe pneumonia. Methods A total of 431 patients with acute stroke treated in Foshan Hospital Traditional Chinese Medicine， Guangdong Province from January 2016 to May 2019 were retrospectively analyzed. According to whether or not with severe pneumonia， they were divided into severe pneumonia group (53 cases) and without severe pneumonia group (378 cases). The risk factors of acute stroke complicated with severe pneumonia， the type of pathogenic bacteria in patients and the results of drug sensitivity were analyzed. Results The age， hospital stay， Glasgow coma scale (GCS) score， national institutes of health stroke scale (NIHSS) score， invasive procedure， chronic obstructive pulmonary disease (COPD) and diabetes were compared between the two groups， and the differences were statistically significant (P < 0.05). Logistic regression analysis showed that age (OR = 1.131)， GCS score (OR = 0.663)， NIHSS score (OR = 2.467)， and invasive procedures (OR = 16.890) were the influencing factors of stroke complicated with severe pneumonia (P < 0.05). Among the 431 patients with acute stroke， 53 cases were secondary to severe pneumonia， with an infection rate of 12.3%. 38 strains of pathogenic bacteria were cultured， including 28 strains of Gram-negative bacteria (73.7%)， 8 strains of Gram-positive bacteria (21.1%)， and 2 strains of fungi (5.2%). The top three Gram-negative bacteria were Pseudomonas aeruginosa， Acinetobacter baumannii， and Escherichia coli. Gram-positive bacteria were mainly Staphylococcus aureus and fungi were Candida albicans. Pseudomonas aeruginosa， Acinetobacter baumannii， Escherichia coli and Klebsiella pneumoniae had a higher resistance rate to Cefazolin， Ceftriaxone， Ciprofloxacin， Levofloxacin and Gentamicin (resistant drug rate>50%); more sensitive to Carbapenem antibiotics meropenem and Imipenem， and Quinolones ciprofloxacin and Levofloxacin (resistance rate<20%). Conclusion In patients with acute stroke， it is necessary to fully evaluate the underlying diseases of patients and adopt an active treatment measure. In terms of pathogenic bacteria， acute stroke complicated with severe pneumonia is mainly caused by Gram-negative. In the choice of early antibiotics， attention should be paid to avoiding the abuse of antibiotics and reducing the emergence of resistant strains., http://www.100md.com(李旷怡 冯锦昉 吴智鑫)
[关键词] 急性脑卒中;重症肺炎;病原菌;危险因素
[中图分类号] R563.1 [文献标识码] A [文章编号] 1673-7210(2020)07(a)-0101-04
[Abstract] Objective To investigate the risk factors and pathogenic bacteria distribution in patients with acute stroke complicated with severe pneumonia. Methods A total of 431 patients with acute stroke treated in Foshan Hospital Traditional Chinese Medicine， Guangdong Province from January 2016 to May 2019 were retrospectively analyzed. According to whether or not with severe pneumonia， they were divided into severe pneumonia group (53 cases) and without severe pneumonia group (378 cases). The risk factors of acute stroke complicated with severe pneumonia， the type of pathogenic bacteria in patients and the results of drug sensitivity were analyzed. Results The age， hospital stay， Glasgow coma scale (GCS) score， national institutes of health stroke scale (NIHSS) score， invasive procedure， chronic obstructive pulmonary disease (COPD) and diabetes were compared between the two groups， and the differences were statistically significant (P < 0.05). Logistic regression analysis showed that age (OR = 1.131)， GCS score (OR = 0.663)， NIHSS score (OR = 2.467)， and invasive procedures (OR = 16.890) were the influencing factors of stroke complicated with severe pneumonia (P < 0.05). Among the 431 patients with acute stroke， 53 cases were secondary to severe pneumonia， with an infection rate of 12.3%. 38 strains of pathogenic bacteria were cultured， including 28 strains of Gram-negative bacteria (73.7%)， 8 strains of Gram-positive bacteria (21.1%)， and 2 strains of fungi (5.2%). The top three Gram-negative bacteria were Pseudomonas aeruginosa， Acinetobacter baumannii， and Escherichia coli. Gram-positive bacteria were mainly Staphylococcus aureus and fungi were Candida albicans. Pseudomonas aeruginosa， Acinetobacter baumannii， Escherichia coli and Klebsiella pneumoniae had a higher resistance rate to Cefazolin， Ceftriaxone， Ciprofloxacin， Levofloxacin and Gentamicin (resistant drug rate>50%); more sensitive to Carbapenem antibiotics meropenem and Imipenem， and Quinolones ciprofloxacin and Levofloxacin (resistance rate<20%). Conclusion In patients with acute stroke， it is necessary to fully evaluate the underlying diseases of patients and adopt an active treatment measure. In terms of pathogenic bacteria， acute stroke complicated with severe pneumonia is mainly caused by Gram-negative. In the choice of early antibiotics， attention should be paid to avoiding the abuse of antibiotics and reducing the emergence of resistant strains., http://www.100md.com(李旷怡 冯锦昉 吴智鑫)