脑卒中相关性肺炎危险因素及临床特点分析

目的分析脑卒中相关性肺炎（SAP）的相关危险因素,并观察其临床特点。方法收集该院神经内科2009年1月—2013年1月收治的150例脑卒中患者的资料,其中35例发作为SAP组,115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分析显示：年龄、糖尿病、房颤致大面积脑梗死、卒中后球肌麻痹（吞咽困难）、气管插管/切开、呼吸机使用等均为SAP发病的高危因素。SAP患者中共培养出菌株20例,主要以痰培养为主,革兰氏阴性杆菌为主要的条件致病菌,包括肺炎克雷伯杆菌（30.00%）、大肠埃希菌（15.00%）、铜绿假单胞菌（15.00%）。金黄色葡萄球菌（25.00%）也不少见,其他如肺炎链球菌及致病性真菌感染相对少见。结果显示其中药敏革兰阴性杆菌对舒巴坦/头孢哌酮保持较高的敏感性,革兰阳性菌对万古霉素最为敏感,耐药性低。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 the Risk Factors and Clinical Characteristics of Stroke Associated Pneumonia

Objective To analyze the relevant risk factors of stroke associated pneumonia（SAP） and observe its clinical characteristics. Methods The clinical data of 150 stroke patients admitted into the Department of Neurology of our hospital from January, 2009 to January, 2013 were collected. Among them, 35 cases occurred SAP were categorized into the SAP group, the rest cases without SAP were selected as the non-SAP group（n=115）. The clinical data like age, gender, diabetes mellitus, atrial fibrillation, stroke type, disturbance of consciousness, trachea cannula or tracheal incision, ventilator supporting and stroke-associated dysphagia, and so on were statistically analyzed in both groups aiming at finding out their relations with the occurrence of SAP. Sputum culture and drug sensitive test in SAP patients were performed, and the results were observed. Results Single and multiple factor logistic analysis indicated that age, diabetes mellitus, atrial fibrillation-related mass cerebral infarct, stroke associated-dysphagia, trachea cannula or tracheal incision, ventilator supporting and disturbance of consciousness were all risk factors leading to the occurrence of SAP. A total of 20 strains of bacteria were mainly isolated from the sputum culture of the SAP patients. Gram negative bacilli were the main pathogens including Klebsiella pneumonia（30.00%） Escherichia coli（15.00%）, Pseudomonas aeruginosa（15.00%）. And Staphylococcus aureus（25.00%） were commonly seen bacteria accounting in SAP. Others like Streptococcus pneumonia and fungus infection were rarely occurred. Outcome of drug sensitive test indicated Gram-negative bacilli kept higher sensitive to Cefoperazone-Sulbactam. Gram-positive bacilli were extremely sensitive to Vancomycin with low resistance. Conclusion There are a number of relevant risk factors of SAP deserving to be paid great attention and taken rational treatment and intervention measures as early as possible, which is significant in preventing the occurrence of associated pneumoni