老年脑卒中患者医院感染的临床特征与影响因素分析

目的探讨老年脑卒中患者医院感染的临床特征及危险因素。方法收集1406例老年脑卒中患者的临床资料，根据是否发生医院感染分为感染组（284例）和非感染组（1122例），分析感染组患者的感染特征，并应用logistic回归对医院感染进行多因素分析。结果感染组患者送检标本分离出351株病原菌[革兰阴性菌221株（63.0%）；革兰阳性菌130株（37.0%）]，以呼吸道、泌尿系统多见。感染组患者年龄、NIHSS评分、糖尿病、吸烟史、意识障碍、吞咽困难、低蛋白血症、侵入性操作、使用质子泵抑制剂者所占比例大于非感染组，住院天数多于非感染组，差异均有统计学意义（P＜0.05或0.01），其中高龄、吸烟史、意识障碍、吞咽困难、NIHSS评分高、低蛋白血症、侵入性操作是神经内科老年脑卒中患者医院感染发生的独立危险因素（均P＜0.05）。结论老年脑卒中患者医院感染发生率高，高龄、吸烟史、意识障碍、吞咽困难、NIHSS评分高、低蛋白血症、侵入性操作是神经内科老年脑卒中患者医院感染发生的危险因素，应充分重视这些影响因素，尽可能减少医院感染的发生率。

Clinical characteristics and risk factors of nosocomial infections in elderly patients with stroke

Objective To explore the clinical characteristics and risk factors of nosocomial infections in elderly patients with stroke. Methods The clinical data of 1 406 cases of elderly patients with stroke were collected.These patients were divided into nosocomial infections group and non-nosocomial infection group and their clinical characteristics were analyzed. Logistic regression analysis was performed to analyze the causes of nosocomial infections. Results Nosocomial infections occurred in 284 patients with the infection rate of 20.2%.The most infection sites were respiratory tract and urinary tract. The most common pathogens causing nosocomial infections are Gram-negitive bacteria which account for 63%.The age was older, the incidence of diabetes, smoke, conscious disturbance, dysphagia, hypoproteinemia, invasive procedure was higher, the NIHSS score was higher and the duration of hospital stay was longer in nosocomial infections group than in non-nosocomial infection group. Older age, smoke, conscious disturbance, dysphagia, higher NIHSS score, hypoproteinemia, invasive procedure were the independent risk factors for nosocomial infections in elderly patients with stroke. Conclusion The incidence of nosocomial infections is still high in elderly patients with stroke, and older age, smoke, conscious disturbance, dysphagia, higher NIHSS score, hypoproteinemia, invasive procedure were the risk factors associated with nosocomial infections for them.More attention should be taken in response to the risk factors so as to effectively reduce its incidence.