脑卒中患者医院获得性肺炎的相关危险因素分析

目的 探讨老年脑卒中患者医院获得性肺炎(HAP)的相关危险因素。方法 采用回顾性调查的方法,对某院1996年1月～2002年5月住院治疗的414例老年脑卒中患者的临床资料进行分析研究。结果 414例老年脑卒中患者中,94例发生HAP,发病率22.71％。通过Logistic回归分析发现,老年脑卒中患者,年龄越大,意识障碍程度越深,球麻痹的程度越重,发生HAP的可能性越大(P<0.001);偏瘫、原有肺部感染、糖尿病、吸引术、曾使用过抗菌药物、鼻饲时间过长,可使发生HAP的可能性升高(P<0.05);性别、早期鼻饲、脑卒中类型与HAP发生关系不大。金黄色葡萄球菌、铜绿假单胞菌、肺炎克雷伯菌、不动杆菌为主要病原菌。结论 老年脑卒中患者HAP的发生与多种因素有关。预防HAP发生的关键是尽量避免HAP的危险因素和正确使用抗菌药物。

Risk factors of nosocomial pneumonia in senile patients with cerebral apoplexy

Objective To study risk factors of hospital acquired pneumonia (HAP) in senile patients with cerebral apoplexy. Methods Four hundred and fourteen senile patients with cerebral apoplexy who were hospitalized from January 1996 to May 2002 were studied. Results Ninety- four of 414 senile patients with cerebral apoplexy developed HAP, the elderly, disturbance of consciousness, severity of bulbar paralysis were significant factors for HAP, HAP was closely related with such factors as hemiplegia, pulmonary infection, diabetes mellitus, suction, antimicrobial use, prolonged nasal feeding; whereas sex, early nasal feeding, and types of cerebral apoplexy had nothing to do with HAP. The main pathogens causing HAP were Staphyloaxcus aureus , Pseudomonas aeruginosa , Klebsiella. pneumonia and Acinetobacter spp. Conclusion HAP in senile patients with cerebral apoplexy was related with many factors, the key to the prevention of HAP was to avoid the risk factors and use antimicrobial rationally.