老年脑卒中患者相关性肺炎危险因素及临床特点分析

目的分析老年脑卒中相关性肺炎（SAP）的相关危险因素,并观察其临床特点。方法收集我科2009年1月-2012年1月收治的180例老年脑卒中患者的资料,其中50例发生SAP作为SAP组,130例未发生SAP作为非SAP组,对两组患者年龄、性别、糖尿病、房颤、卒中类型、意识障碍、气管插管/切开、呼吸机使用、吞咽困难等临床资料进行统计分析,观察其与SAP发生的关系,同时观察对SAP患者进行痰培养并进行药敏试验的结果。结果单因素及多因素Logistic分析结果显示,年龄、糖尿病、房颤、吞咽困难、气管插管/切开、呼吸机使用及意识障碍等均为SAP发病的危险因素,性别、高血压及卒中类型不是SAP病的危险因素。SAP患者中,30例痰培养阳性,以金黄色葡萄球菌（30.00%）、肺炎克雷伯杆菌（23.33%）最为多见,其次为大肠埃希菌（16.67%）、铜绿假单胞菌（16.67%）及肺炎链球菌（6.67%）,真菌感染较少见,药敏试验结果显示革兰阴性杆菌对亚胺培南保持较高的敏感染,耐药性低,革兰阳性菌对万古霉素最为敏感。结论 SAP的相关危险因素较多,临床上应引起重视并尽早采取合理的治疗和干预措施,对防治相关性肺炎的发生具有重要意义。

Analysis of risk factors and clinical characteristics of senile stroke associated pneumonia

Objective To analyze relevant risk factors of senile stroke associated pneumonia（SAP） and observe its clinical characteristics.Methods Clinical data from 180 senile stroke patients admitted into our department from January 2009 to January 2012 were collected.Among them,all 50 cases occurred SAP patients were categorized into SAP group,the rest into non-SAP group（n = 130）.Clinical data like age,gender,diabetes mellitus,atrial fibrillation,stroke type,disturbance of consciousness,trachea cannula or tracheal incision,ventilator supporting and dysphagia,etc were statistically analyzed in both groups aiming at finding out their relations with occurrence of SAP.Sputum culture and drug sensitive test in SAP patients were performed.Results Single and multiple factor Logistic analysis indicated age,diabetes mellitus,atrial fibrillation,dysphagia,trachea cannula or tracheal incision,ventilator supporting and disturbance of consciousness were all risk factors leading to occurrence of SAP.However,gender,hypertension and stroke type were not obviously related.In sputum culture,30 patients were positive.Staphylococcus aureus and Klebsiella pneumonia were two most commonly-seen bacteria accounting for 30.00% and 23.33% respectively.Fungus infection was rarely occurred.Between them,there were Escherichia coli,Pseudomonas aeruginosa,and Streptococcus pneumonia with the percentages of 16.67%,16.67% and 6.67% in turn.Outcome from drug sensitive test indicated Gram-negative bacilli kept higher sensitive to Imipenem with low resistance.Gram-positive bacilli were extremely sensitive to Vancomycin.Conclusion There are a number of relevant risk factors in senile SAP deserving to be paid great attention and taken rational treatment and intervention measures as early as possible,which is significant in preventing occurrence of associated pneumonia.