【摘要】：目的探討SAP的感染情況和病死率,以及影響其發(fā)展的重要因素;分析痰培養(yǎng)病原菌的種類。方法選擇2014年9月至2015年9月在寧夏醫(yī)科大學(xué)總醫(yī)院住院的1324例腦卒中患者,其中包括1059例腦梗死患者和265例腦出血患者,分析我院SAP的感染情況;將合并肺炎者作為SAP組,共132例,未合并肺炎者132例為非SAP組,對患者基本信息(年齡、性別)、既往情況(包括糖尿病、心臟病、慢性肺病、卒中史、吸煙史)、臨床癥狀{包括NIHSS評分(NIH Stroke Scale,NIHSS)、吞咽障礙、意識障礙}、入院后治療{如鼻飼治療、抑酸劑{質(zhì)子泵抑制劑(Proton pump inhibitors,PPIs)及H2受體阻滯劑(histamine2-receptor antagonists,H2Ras)}的使用、脫水劑的使用}及其他情況(住院費(fèi)用、住院天數(shù))進(jìn)行統(tǒng)計(jì)分析。全部數(shù)據(jù)采取SPSS19.0統(tǒng)計(jì),組間定量資料應(yīng)用t檢驗(yàn),對定性資料采用c2檢驗(yàn),篩選出影響SAP發(fā)生的因素(檢驗(yàn)水準(zhǔn)a=0.05)。之后將上述因素進(jìn)行Logistic回歸;同時(shí),整理出痰培養(yǎng)的病原菌分布情況及藥敏結(jié)果。結(jié)果1.1324例腦卒中病人中合并SAP者132例,SAP發(fā)生率為9.97%,其中腦梗死87例,占SAP組的65.9%,腦出血45例,占SAP組的34.1%。腦卒中患者總的病死人數(shù)為10人,病死率為0.76%,SAP組病死人數(shù)為5人,病死率為3.79%,原因分別為腦干功能衰竭(2例)、腦疝(1例)、肺炎、呼吸功能衰竭(1例)及多臟器功能衰竭(1例);非SAP組死亡0人,死亡率為0%,兩組死亡率無明顯差異(c2=3.262,P0.05)。2.SAP組的平均住院天數(shù)和費(fèi)用均明顯大于非SAP組(P0.05)。3.單因素分析時(shí),年齡(≥65歲)、性別、卒中類型、心臟病、NIHSS評分(≥10分)、意識障礙、吞咽障礙、抑酸劑、脫水劑使用、鼻飼治療等10個(gè)因素兩組間對比差別有統(tǒng)計(jì)學(xué)意義(P0.05)。4.二元Logistic回歸后,得出年齡、鼻飼治療、使用脫水劑、NIHSS評分(≥10分)可能為SAP獨(dú)立的危險(xiǎn)因素。5.SAP組132例患者中送檢痰培養(yǎng)者59例(44.7%),共送檢痰培養(yǎng)標(biāo)本165例,培養(yǎng)出病原體18種,44株,檢出病原菌者101例,檢出率為76.52%,其中檢出革蘭氏陰性桿菌占88.64%,分別為鮑曼不動(dòng)桿菌、大腸桿菌、肺炎克雷伯桿菌、銅綠假單胞菌、流感嗜血桿菌等;革蘭氏陽性球菌占4.55%;真菌占6.82%。6.病原菌及其對常用抗生素敏感性大小:鮑曼不動(dòng)桿菌敏感的抗菌藥物為復(fù)方新諾明、米諾環(huán)素、亞胺培南等;大腸桿菌敏感的抗菌藥物為阿米卡星、頭孢替坦、亞胺培南等;肺炎克雷伯桿菌敏感的抗菌藥物為亞胺培南、左氧氟沙星、頭孢他啶等;銅綠假單胞菌敏感的抗菌藥物是阿米卡星、亞胺培南、左氧氟沙星等;金黃色葡萄球菌敏感的抗菌藥物有替考拉寧、萬古霉素、莫西沙星等。結(jié)論1.年齡(≥65歲)、NIHSS評分(≥10分)可能為SAP的獨(dú)立危險(xiǎn)因素;2.卒中相關(guān)性肺炎患者痰培養(yǎng)病原體多為革蘭氏陰性桿菌,包括鮑曼不動(dòng)桿菌、大腸桿菌等;革蘭氏陽性球菌以金黃色葡萄球菌為主,真菌以白色念珠菌為主。
[Abstract]:Objective to investigate the infection and mortality of SAP and the important factors affecting its development, and to analyze the types of pathogenic bacteria in sputum culture. Methods 1324 stroke patients, including 1059 patients with cerebral infarction and 265 patients with cerebral hemorrhage, who were hospitalized in General Hospital of Ningxia Medical University from September 2014 to September 2015, were selected to analyze the infection of SAP in our hospital. There were 132 patients with pneumonia as SAP group, 132 patients without pneumonia as non-SAP group. The basic information (age, sex), past condition (including diabetes mellitus, heart disease, chronic lung disease, stroke history, smoking history) of the patients were analyzed, including diabetes mellitus, heart disease, chronic lung disease, stroke history and smoking history. Clinical symptoms {including NIHSS score (NIH Stroke Scale,NIHSS), dysphagia, disturbance of consciousness}, post-admission treatment {such as nasal feeding, acid suppressant {proton pump inhibitor (Proton pump inhibitors,PPIs] and H 2 receptor blocker (histamine2-receptor antagonists,) Use of H2Ras}, use of dehydrating agent} and other conditions (hospitalization costs, hospital days) for statistical analysis. All the data were collected by SPSS19.0 statistics, the quantitative data between groups were tested by t test, and the qualitative data were analyzed by c2 test. The factors affecting the occurrence of SAP were screened out (test level a0. 05). After that, the above factors were analyzed by Logistic regression, and the distribution of pathogenic bacteria and drug sensitivity of sputum culture were sorted out. Results among the 1.1324 stroke patients, 132 cases were complicated with SAP, and the incidence of SAP was 9.97. There were 87 cases of cerebral infarction (65.9% of SAP group) and 45 cases of cerebral hemorrhage (34.1% of SAP group). The total number of patients with stroke was 10, the mortality was 0.76%, and the mortality was 3.79 in SAP group. The causes were brainstem failure (2 cases), hernia (1 case) and pneumonia. Respiratory failure (1 case) and multiple organ failure (1 case); There was no significant difference in mortality between the two groups (c2n3.262, P0.05). The average hospitalization days and expenses in 2.SAP group were significantly higher than those in non-SAP group (P0.05). In univariate analysis, age (鈮，

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