脑卒中患者鼻饲管肺炎的临床分析

目的探讨脑卒中患者发生鼻饲管肺炎的临床特点、发生机制及预防方法。方法对我院住院的留置鼻饲管的脑卒中患者，采用回顾性研究的方法，分析患者在置管期间发生返流、呛咳、误吸、吸入性肺炎的情况。结果脑卒中患者发生鼻饲管肺炎，均有不同程度的返流、呛咳及误吸。临床表现主要为咳嗽、咯痰和发热。胸部X线检查表现为吸入部位的浸润影。鼻饲管肺炎患者与未发生鼻饲管肺炎的患者在年龄、置管时间、神经功能缺损评分等方面的差异有统计学意义（P〈0．05），两者在吞咽障碍、并发症方面差异有显著性（P〈0．01），而未发生鼻饲管肺炎相应的并发症少。感染以革兰氏阴性菌居多，占72．7％。以铜绿假单孢菌最常见，其次为肺炎克雷伯菌。结论胃管鼻饲虽能解决进食问题，但患者仍会出现吸入性肺炎、胃食管返流、营养不良等并发症。要预防鼻饲管肺炎，除注意鼻饲管的护理外，还应加强口腔护理；治疗吞咽障碍及进行早期康复。如果4周后仍不能拔除鼻饲管，恢复不了正常的吞咽功能，就需胃造瘘术。

Clinical analysis of stroke patients with nosocomial pneumonia

Objective To investigate the clinical features,mechanism and prevention of stroke patients with nosoeomial pneumonia. Methods A retrospective study was performed on the stroke patients with nasal feeding tube kept in hospital. Refluxing, choking cough, aspiration, and aspiration pneumonia during nasal feeding tube, were all recorded and compared. Results There were different degrees of reflux, choking cough and aspiration in stroke patients with nosocomial pneumonia. The main clinical features included cough, expectoration and fever. Chest x-ray examination revealed infiltrations of the lungs. To patients with nosocomial pneumonia and no Pneumonia patients with nasal feeding tube, the difference were statistically significant in the area of the age, tube time and neurological deficit scores（ P 〈 0. 05 ）, and was also in the aspect of dysphagia, complications （P 〈 0. 01 ）. Gram-negative bacteria infection in the majority, accounting for 72. 7%. Pseudomonas aeruginosa was the most common, followed by Klebsiella pneumoniae. Conclusion Although the nasal feeding tube was able to solve the problem of eating, but there would still be in patients with aspiration pneumonia, gastroesophageal reflux, malnutrition and other complications. To prevent nosocomial pneumonia, in addition to the attention of the nasal feeding tube care ,we mustalso strengthen oral care; Dysphagia treatment and early rehabilitation. If not removal of nasal feeding tube after 4 weeks, unable to resume normal swallowing function, to be on the gastrostomy.