脑梗死患者肺部感染的病原菌分析及临床特点与防治措施

发布时间：2018-05-21 12:02

本文选题：脑梗死 + 肺部感染　；参考：《中华医院感染学杂志》2017年24期

【摘要】：目的探讨脑梗死患者肺部感染的病原菌分析、临床特点及防治措施,为临床预防及治疗提供思路。方法选取2013年1月-2016年12月于医院神经内科收治的脑梗死患者320例;其中合并肺部感染患者124例为肺部感染组,非肺部感染患者196例为非肺部感染组,患者经影像学诊断明确脑梗死发生部位,进行NIHSS(美国国立卫生院卒中量表)评分、Barthel(日常生活能力评定)评分,行实验室检查比较两组患者白细胞总数(WBC)、血红蛋白(Hb)、急性C-反应蛋白(CRP)、血沉(ESR)、全血高切粘度等指标。结果非肺部感染组NIHSS评分、WBC、全血高切粘度、CRP、ESR均低于肺部感染组,Hb、Barthel高于肺部感染组(P0.05);脑梗死合并肺部感染患者痰液标本中共检出98份标本微生物,以革兰阴性菌为主,共68株占69.39%。结论大面积脑梗死及多病灶脑梗死患者肺部感染率较高,NIHSS、Barthel评分均与肺部感染风险正相关,而肺部感染病原菌以革兰阴性菌所占比重更大,临床针对此类患者应早期着手监测,关注患者临床体征及实验室指标并采取有效措施以降低脑梗死患者肺部感染发生风险。
[Abstract]:Objective to explore the pathogenic bacteria analysis, clinical characteristics and prevention and treatment of pulmonary infection in patients with cerebral infarction, and to provide ideas for clinical prevention and treatment. Methods A total of 320 patients with cerebral infarction were selected from January 2013 to December 2016 in the Department of Neurology, including 124 patients with pulmonary infection and 196 patients with non-pulmonary infection. The location of cerebral infarction was determined by imaging diagnosis. NIHSS (National Institutes of Health Stroke scale) score and Barthel score were evaluated. The white blood cell count (WBC), hemoglobin (HB), acute C-reactive protein (ARP), erythrocyte sedimentation rate (ESR) and whole blood high shear viscosity were compared between the two groups. Results the NIHSS score and the whole blood high shear viscosity of NIHSS in the non-pulmonary infection group were lower than those in the pulmonary infection group (P 0.05), and 98 specimens of microbes were detected in sputum of patients with cerebral infarction and pulmonary infection, 68 of them were Gram-negative bacteria (69.39%). Conclusion the lung infection rate of patients with large area cerebral infarction and multi-focus cerebral infarction is higher than that of the patients with multiple focus cerebral infarction. The scores of NIHSS Barthel are positively correlated with the risk of pulmonary infection, and the pathogens of pulmonary infection are Gram-negative bacteria, which should be monitored early in clinic. Focus on the clinical signs and laboratory indicators and take effective measures to reduce the risk of pulmonary infection in patients with cerebral infarction.
【作者单位】：诸暨市人民医院神经内科;
【基金】：浙江省医药卫生基金资助项目(2014KYA002)
【分类号】：R563.1;R743.3

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