脑卒中老年患者医院获得性肺炎相关因素分析

目的探讨脑卒中老年患者医院获得性肺炎(hospitalacquiredpneumonia,HAP)的相关因素。方法采用回顾性调查的方法,对我院老年病科2000年7月～2003年6月住院治疗的430例老年脑卒中患者的临床资料进行分析研究。结果430例老年脑卒中患者中,145例发生HAP,发生率为33.7%。其中脑出血82例,蛛网膜下腔出血10例,共发生HAP46例(50%);脑梗死338例,发生HAP99例(29%)。通过对痰液中分离出的致病菌分析,发现HAP常见病原菌分别是金黄色葡萄球菌、铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌、嗜麦芽假单胞菌、大肠埃希菌、白色念球菌等。结论老年脑卒中患者HAP的发生与多种因素有关,其中住院时间长,呼吸道侵入性操作、反复使用抗生素是脑卒中老年HAP患者的易感因素。预防HAP发生的关键是尽量避免其危险因素,加强护理,早期预防,及时诊断。

Risk Assessment of Hospital Acquired Pneumonia (HAP) in Senile Patients with Cerebral Apoplexy

Objective To study the risk factors of hospital acquired pneumonia (HAP) in senile patients with cerebral apoplexy. Method A retrospective review of 430 senile patients with cerebral apoplexy between July 2000 and June 2003 were performed. Result A total of 145 senile patients with cerebral apoplexy were found to have HAP (33.7%). Out of these 145 patients, 82 suffered cerebral hemorrhage and 10 suffered subarachnoid hemorrhage, in which 46 developed HAP(50%). 338 suffered from cerebral infarction,in which 99 developed HAP(29%). Microbiological analysis of sputum samples revealed that Staphylococcus aureus, Pseudomonas aeruginosa, Baumanii, Klebsiella pneumonia, Pseudomonas maltophilia, Escherichia coli, and Candida albicans were the major type of pathogens. Conclusion Mulitple factors are involved in the development of HAP in senile patients with cerebral apoplexy. These include the time of staying in hospital, intrusive performance in respiratory tract, and the use of antibiotics. The key to the prevention of HAP relies on the successful risk management and early diagnosis.