摘要
目的 探讨中老年脑卒中相关性肺炎的流行病学特征、危险因素及病原菌分布情况.方法 回顾性选取 2020 年 1月至 2023 年 9 月于丽水市第二人民医院治疗的 822 例中老年脑卒中患者,根据是否发生脑卒中相关性肺炎将其分为发生组(n=217)和未发生组(n=605).收集两组患者的临床资料、病原菌培养及药敏试验结果.结果 两组患者的年龄、住院时间、吸烟史、糖尿病、高血压、意识障碍、吞咽障碍、入院时美国国立卫生研究院卒中量表(National Institutes of Health stroke scale,NIHSS)评分、低蛋白血症、是否留置胃管比较差异均有统计学意义(P<0.05).Logistic回归分析显示,年龄>65 岁、住院时间≥15d、吸烟史、糖尿病、意识障碍、吞咽障碍、入院时NIHSS评分≥13 分、留置胃管均是脑卒中相关性肺炎的危险因素(P<0.05).217 例脑卒中相关性肺炎患者的痰液中共培养出 251 株致病菌,包括革兰阴性菌 168 株,革兰阳性菌 72 株,真菌 11 株.主要病原菌为肺炎克雷伯菌 68 株(27.1%)、铜绿假单胞菌 50 株(19.9%)、金黄色葡萄球菌 41 株(16.3%)、鲍曼不动杆菌 25 株(10.0%).肺炎克雷伯菌对氨苄西林、庆大霉素的耐药率较高,铜绿假单胞菌、金黄色葡萄球菌、鲍曼不动杆菌对氨苄西林、阿莫西林的耐药率均较高.结论 中老年脑卒中相关性肺炎的发生和年龄、合并基础疾病、意识障碍、吞咽障碍、留置胃管等有关,且感染病原菌种类较多,临床上应加强识别高危因素,并根据药敏试验选择适当的抗菌药物治疗.
Abstract
Objective To explore the epidemiological characteristics,risk factors,and pathogen distribution of stroke associated pneumonia in middle-aged and elderly patients.Methods A total of 822 middle-aged and elderly stroke patients treated in Second People's Hospital of Lishui from January 2020 to September 2023 were retrospectively selected,and they were divided into incidence group(n=217)and non-incidence group(n=605)based on the occurrence of stroke associated pneumonia.Clinical data,pathogen culture and drug sensitivity test results of two groups of patients were collected.Results There were significant differences in age,length of stay,smoking history,diabetes mellitus,hypertension,disturbance of consciousness,dysphagia,National Institutes of Health stroke scale(NIHSS)score at admission,hypoproteinemia,and gastric tube indwelling or not between two groups(P<0.05).Logistic regression analysis showed that age>65 years,length of stay≥15 days,smoking history,diabetes mellitus,disturbance of consciousness,dysphagia,NIHSS score≥13 points at admission,and indwelling gastric tube were risk factors for stroke associated pneumonia(P<0.05).A total of 251 pathogenic bacterial strains were cultured in the sputum of 217 patients,including 168 Gram negative bacteria,72 Gram positive bacteria,and 11 fungi.The main pathogens were 68 strains of Klebsiella pneumoniae(27.1%),50 strains of Pseudomonas aeruginosa(19.9%),41 strains of Staphylococcus aureus(16.3%),and 25 strains of Acinetobacter baumannii(10.0%).Klebsiella pneumoniae had a higher resistance rate to ampicillin and gentamicin,while Pseudomonas aeruginosa,Staphylococcus aureus,and Acinetobacter baumannii had a higher resistance rate to ampicillin and amoxicillin.Conclusion The occurrence of stroke associated pneumonia in middle-aged and elderly patients is related to age,comorbidities,disturbance of consciousness,dysphagia,indwelling gastric tubes,etc.,and there are many types of infectious pathogens.In clinical practice,it is necessary to strengthen the identification of high-risk factors and select appropriate antibiotics for treatment based on drug sensitivity tests.
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