卒中相关性肺炎病原菌分布、耐药情况及危险因素分析

目的:研究本地区卒中相关性肺炎（SAP）病原菌分布、耐药情况及导致该疾病产生的主要危险因素。方法:回顾性研究天津市第四中心医院ICU、中国人民解放军第四六四医院ICU、天津医科大学总医院空港医院SAP患者资料, 根据1995年全国第四届脑血管病会议修订的脑卒中诊断标准，并经头颅CT或MRI证实，包括缺血性卒中（脑梗死）和出血性卒中（脑出血）分为SAP组276例和非SAP组234例，分析病原菌分布情况及抗生素耐药情况，同时评估多项相关危险因素。结果:革兰阴性杆菌是导致SAP发病的主要菌群，主要有铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌、鲍曼不动杆菌、阴沟肠杆菌等；革兰阳性球菌有金黄色葡萄球菌、表皮葡萄球菌、肺炎链球菌等。SAP发病与高龄、卒中病史、高血压、糖尿病、吸烟史等有关。结论:SAP病原菌以革兰阴性杆菌为主，且存在不同程度耐药性，与医院获得性肺炎的病原菌大致相同，危险因素包括高龄、卒中病史、高血压、糖尿病、吸烟史等。

Distribution,drug resistance and risk factors of pathogenic bacteria in patients with stroke-associated pneumonia

Objective: To investigate the distribution and drug resistance of stroke-associated pneumonia (SAP) pathogens and the main risk factors leading to the disease. Methods:Data of the patients of the ICU in the Fourth Central Hospital of Tianjin, the ICU in the 464th Hospital of the People’s Liberation Army, and the stroke-related pneumonia in the Tianjin General Hospital of Tianjin Medical University Airport Hosptial was retrospectively studied. According to the revised diagnostic criteria for stroke in the Fourth National Conference on Cerebrovascular Diseases in 1995, and confirmed by head CT or MRI, patients with ischemic stroke(cerebral infarction) and hemorrhagic stroke (cerebral hemorrhage) were divided into SAP group（276 cases）and non-SAP group（234 cases）. The distribution of pathogens and antibiotic resistance were analyzed. Meanwhile, a number of relevant risk factors were assessed. Results: Gram-negative bacilli were the main bacteria leading to the onset of SAP, mainly including Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Acinetobacter baumannii, Enterobacter cloacae, etc. Gram-positive cocci included Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, and so on. The incidence of SAP was related to advanced age, history of stroke, hypertension, diabetes, history of smoking, etc. Conclusion: The pathogens of SAP are mainly Gram-negative bacilli with different degrees of drug resistance, which are almost the same as that of hospital-acquired pneumonia. Risk factors include advanced age, history of stroke, hypertension, diabetes, and history of smoking.