【摘要】：目的探討腦梗死患者伴肺部感染特點(diǎn),并對(duì)相關(guān)因素加以分析,為臨床防止腦梗死患者發(fā)生肺部感染提供參考。方法選取2014年1月-2016年8月醫(yī)院住院治療的500例腦梗死患者,將未發(fā)生感染的患者作為對(duì)照組,發(fā)生肺部感染的患者為觀察組;對(duì)患者臨床病例資料、診治情況等加以分析,對(duì)腦梗死患者伴肺部感染發(fā)生因素加以分析,并對(duì)有統(tǒng)計(jì)學(xué)意義的單因素行l(wèi)ogistic多因素回歸分析,同時(shí)對(duì)感染患者進(jìn)行痰液培養(yǎng),了解其病原菌分布。結(jié)果 500例腦梗死患者中發(fā)生肺部感染32例,感染率為6.4%;經(jīng)痰液檢測(cè)發(fā)現(xiàn),32例腦梗死伴肺部感染患者共檢出病原菌40株,其中革蘭陰性菌28株占70.0%;革蘭陽(yáng)性菌9株占22.5%;真菌3株占7.5%;主要病原菌為銅綠假單胞菌、大腸埃希菌、金黃色葡萄球菌;觀察組患者PH值為(7.05±0.02)明顯低于對(duì)照組(7.51±0.07);PaO_2為(7.98±2.01)KPa明顯低于對(duì)照組(10.36±0.71)KPa;PaCO_2為(6.19±0.57)KPa明顯高于對(duì)照組(5.27±0.31)KPa;TNF-α為(0.27±0.02)μg/L明顯高于對(duì)照組(0.07±0.02)μg/L;IL-6為(0.27±0.14)μg/L明顯高于對(duì)照組(0.08±0.04)μg/L,以上指標(biāo)兩組比較,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);單因素分析發(fā)現(xiàn),吸煙、使用呼吸機(jī)、氣管插管、臥床時(shí)間、留置鼻飼管、慢性心功能不全、侵入性操作、意識(shí)障礙、年齡、糖尿病、肌力Ⅱ級(jí)以下、COPD、球麻痹為腦梗死患者伴肺部感染的影響因素;經(jīng)多因素logistic回歸分析發(fā)現(xiàn),年齡、侵入性操作、氣管插管、臥床時(shí)間、意識(shí)障礙、留置鼻飼管、使用呼吸機(jī)、糖尿病、肌力Ⅱ級(jí)以下、COPD、球麻痹為腦梗死患者伴肺部感染的高危因素。結(jié)論腦梗死患者伴肺部感染的影響因素較多,臨床醫(yī)師需加強(qiáng)對(duì)腦梗死患者病情的觀察,減少侵入性操作等,制定合理有效防治對(duì)策,同時(shí)根據(jù)病原菌特點(diǎn)積極選擇合理抗菌藥物,以更好的改善患者預(yù)后。
[Abstract]:Objective to explore the characteristics of pulmonary infection in patients with cerebral infarction and analyze the related factors to provide reference for clinical prevention of pulmonary infection in patients with cerebral infarction. Methods 500 patients with cerebral infarction who were hospitalized in hospital from January 2014 to August 2016 were selected as the control group and the patients with pulmonary infection as the observation group, and the clinical data, diagnosis and treatment of the patients were analyzed. The causes of pulmonary infection in patients with cerebral infarction were analyzed, and logistic multivariate regression analysis was performed on the single factor with statistical significance, and sputum culture was carried out to understand the distribution of pathogenic bacteria in the infected patients. Results there were 32 cases of pulmonary infection in 500 patients with cerebral infarction, the infection rate was 6.4%, 40 strains of pathogenic bacteria were detected by sputum examination in 32 cases of cerebral infarction with pulmonary infection. Among them, 28 Gram-negative bacteria accounted for 70.0m, 9 Gram-positive bacteria accounted for 22.5B, 3 fungi accounted for 7.5.The main pathogens were Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus; The PH value of the patients in the observation group was (7.05 鹵0.02) significantly lower than that in the control group (7.51 鹵0.07) PaO-2 (7.98 鹵2.01) KPa was significantly lower than that in the control group (10.36 鹵0.71) KPa;PaCO_2 was (6.19 鹵0.57) KPa, significantly higher than that in the control group (5.27 鹵0.31) KPa;TNF- 偽 (0.27 鹵0.02) 渭 g / L was significantly higher than that in the control group (0.07 鹵0.02) 渭 g / L IL-6 was (0.27 鹵0.14) 渭 g / L significantly higher than that in the control group (0.08 鹵0.04) 渭 g / L. Single factor analysis showed that smoking, ventilator, tracheal intubation, bed rest, nasal feeding tube, chronic cardiac insufficiency, invasive operation, disturbance of consciousness, age, diabetes mellitus, Logistic regression analysis showed that age, invasive operation, tracheal intubation, bed-rest time, consciousness disorder, nasal feeding tube, ventilator were used in patients with cerebral infarction. Diabetes mellitus, muscle strength below grade 鈪，

本文編號(hào)：2218279