糖尿病并发脑梗死患者医院感染危险因素分析

目的探讨糖尿病脑梗死患者医院感染的临床特点、危险因素分析及防治对策。方法通过回顾性调查方法，对发生医院感染的糖尿病脑梗死患者124例和未发生医院感染的糖尿病脑梗死患者116例的临床数据进行对比及回归分析。结果医院感染患者大灶性脑梗死多见，神经功能缺损程度严重，住院天数明显延长，临床疗效差。侵袭性操作、抗生素预防性应用、神经功能缺损程度、空腹血糖、尿白蛋白、脑梗死灶大小、血浆白蛋白／球蛋白、住院天数为医院感染的危险因素。感染部位以下呼吸道（占41．5％）和泌尿道（28．1％）为主。8．9％为二部位感染。病原菌主要为肺炎克雷伯氏菌（占16．7％）、铜绿假单胞菌（15．9％）、白色念珠菌（12．1％）和大肠埃希氏菌（12．1％）等。结论糖尿病脑梗死医院感染患者病情严重，预后不良。针对危险因素采取有效防治措施，对降低其医院感染率和改善患者生活质量具有重要作用。

Study on the risk factors of nosocomial infection in diabetic patients complicated with cerebral infarction and discussion on control measures

Objective To investigate the clinical characters of patients, risk factors and preventive measures of nosocomial infection in diabetic cerebral infarction. Methods The clinical datas were compared and logistic regression analysis was performed to reveal the risk factors of nosocomial infection in diabetic cerebral infarction on a retrospective basis by reviewing the patients medical records. Results The clinical characters of nosocomial infection in diabetic cerebral infarction were that large cerebral infarction and severity neurological deficits were very common. The patients always had long hospitalization days and poor prognosis. Invasive operation, antibiotic prophylaxis, severity neurological deficits, fasting plasma glucose, urinary albumin, size of cerebral infarction,albumin/globulin and hospitalization days were the risk factors for nosocomial infection in diabetic cerebral infarction. Among the patients, nosocomial lower respiratory tract infection was the highest (41.5%), the second one was urinary tract infection (28.1%). The case that both sites of infected was common (8.9%). Klebsiella pneumoniae (16.7%), Pseudomonas aeruginosa (15.9%), Candida albicans (12.1%) and Escherichia coli (12.1%) were the most frequent pathogens. Conclusion The patient's condition of nosocomial infection in diabetic cerebral infarction was serious and had poor prognosis. Taking preventive measures according to the risk factors could reduce the infection rate.