脑卒中患者发生院内感染的临床情况及血免疫指标影响研究

目的探讨脑卒中患者发生院内感染的临床情况以及免疫功能影响,为临床诊疗提供参考依据。方法回顾性分析2016年1月—2018年1月在我院就诊的360例脑卒中患者的临床资料。统计医院感染的发生率,并根据患者是否发生院内感染分为感染组(n=55)和未感染组(n=305)。统计分析患者感染部位、病原菌分布及影响因素,分析免疫功能免疫球蛋白A(immunoglobulin A,IgA)、IgG、补体3(complement 3,C3)、C4对患者的影响。结果360例脑卒中患者中男190例,女170例,年龄45~75岁,平均(60.12±4.89)岁。感染组以肺部感染为主,占比58.18%。55例感染患者共分离出病原菌76株,以革兰阴性菌为主,占比55.26%(42/76),其次为革兰阳性菌,占比31.58%(24/76),最后为真菌,占比13.16%(10/76)。年龄,性别,意识障碍,侵入性操作,住院天数,机械通气,吞咽困难,糖尿病,IgA、IgG、C3及C4水平下降与脑卒中患者发生院内感染有关(P均<0.05);多因素Logistic回归分析结果显示,意识障碍,性别,侵入性操作,机械通气,吞咽困难,糖尿病,IgA、IgG、C3及C4水平下降等是脑卒中患者发生院内感染的独立危险因素(P均<0.05)。结论脑卒中患者院内感染发生率较高,意识障碍,性别,侵入性操作,机械通气,吞咽困难,糖尿病,IgA、IgG、C3及C4水平下降等是脑卒中患者发生院内感染的独立危险因素,免疫功能降低与脑卒中患者发生院内感染密切相关,临床应注重对患者免疫功能监测,适当增强患者自身免疫功能。

Clinical situation and the influence on blood immune index in stroke patients with nosocomial infection

Objective To explore the clinical situation of nosocomial infection in stroke patients and the influence of immune function,so as to provide reference for clinical diagnosis and treatment.Methods The clinical data of 360 stroke patients admitted to our hospital from January 2016 to January 2018 were retrospectively analyzed.The incidence of nosocomial infection was analyzed,and the included patients were divided into infection group(n=55)and non-infection group(n=305)according to the presence/absence of nosocomial infection.The infected site,distribution of pathogenic bacteria and influencing factors were also analyzed.The effects of immunoglobulin A(IgA),IgG,complement 3(C3)and C4 on the patients were investigated.Results Among 360 stroke patients,there were 190 males and 170 females.They aged 45-75 years with a mean age of(60.12±4.89)years.In the infection group,pulmonary infection was predominant,accounting for 58.18%.A total of 76 strains of pathogenic bacteria were isolated from 55 infected patients.The principal bacteria was gram-negative bacteria,accounting for 55.26%(42/76),followed by gram-positive bacteria,accounting for 31.58%(24/76),and fungi,accounting for 13.16%(10/76).Age,sex,disturbance of consciousness,invasive operation,hospitalization days,mechanical ventilation,dysphagia,diabetes mellitus,decline of IgA,IgG,C3 and C4 levels were associated with nosocomial infection in stroke patients(P<0.05).Multivariate Logistic regression analysis showed that independent risk factors for nosocomial infection in stroke patients included disturbance of consciousness,sex,invasive operation,mechanical ventilation,dysphagia,diabetes mellitus,decline of IgA,IgG,C3 and C4 levels(P<0.05).Conclusions The incidence of nosocomial infection in stroke patients is relatively high.Independent risk factors for nosocomial infection in stroke patients are consciousness disturbance,sex,invasive operation,mechanical ventilation,dysphagia,diabetes mellitus,decline of IgA,IgG,C3 and C4 levels.Decreased immune function is closely related to nosocomial infection in stroke patients.The immune function monitoring of patients should be emphasized in clinical practice and the autoimmune function of patients should be properly enhanced.