老年急性脑梗死患者肺部感染临床特点及治疗分析

发布时间：2019-04-18 23:31

【摘要】：目的分析老年急性脑梗死患者肺部感染的临床特点,并提出针对性的诊治策略。方法选择2012年1月-2013年1月神经内科36例急性脑梗死肺部感染老年患者作为研究组,同时选择同期急性脑梗死无肺部感染老年患者50例作为对照组,对两组患者脑梗死类型、神经功能缺损评分、美国国立卫生院神经功能缺损评分、吞咽功能障碍严重程度及营养状况评估进行比较,采集肺部感染患者痰标本进行培养及药敏试验,数据采用SPSS13.0软件进行统计处理。结果研究组患者神经功能缺损评分、美国国立卫生院神经功能缺损评分均高于对照组,研究组患者动脉血氧分压、血清总蛋白较对照组低,降钙素原高于对照组,研究组以大面积梗死与多灶性梗死型为主,分别占63.9%、55.6%;对照组以腔隙性梗死与小片梗死为主,分别占52.0%、78.0%;两组比较差异有统计学意义(P0.05);肺部感染患者送检标本检出病原菌36株,革兰阴性杆菌占63.9%,真菌占19.4%,革兰阳性球菌占16.7%;36例肺部感染患者中33例经规范化治疗后呼吸功能及肺部感染明显改善。结论神经功能缺损评分、美国国立卫生院神经功能缺损评分高、营养状况差、吞咽功能障碍及大面积脑梗死与多灶性梗死患者容易并发肺部感染;密切检测患者体温与临床体征变化,早期及时诊断肺部感染,使用敏感抗菌药物治疗等是治疗的有效措施。
[Abstract]:Objective to analyze the clinical features of pulmonary infection in elderly patients with acute cerebral infarction (ACI). Methods from January 2012 to January 2013, 36 elderly patients with acute cerebral infarction with pulmonary infection were selected as the study group, 50 elderly patients with acute cerebral infarction without pulmonary infection as the control group, and 50 patients with acute cerebral infarction without pulmonary infection as the control group. The neurological impairment score, the neurological deficit score, the severity of dysphagia and nutritional status were compared. Sputum samples from patients with pulmonary infection were collected for culture and drug sensitivity test. The data were processed by SPSS13.0 software. Results the neurological deficit scores of the patients in the study group were higher than those in the control group. The arterial oxygen partial pressure, serum total protein and procalcitonin were lower in the study group than in the control group, and the level of procalcitonin was higher in the study group than in the control group. In the study group, large area infarction and multi-focal infarction were the main types, accounting for 63.9% and 55.6%, respectively. Lacunar infarction and patchy infarction were the main ones in the control group, accounting for 52.0% and 78.0% respectively; there was significant difference between the two groups (P0.05). 36 strains of pathogenic bacteria were detected in the samples of patients with pulmonary infection. Gram-negative bacilli accounted for 63.9%, fungi 19.4% and gram-positive cocci 16.7%. The respiratory function and pulmonary infection were improved in 33 of 36 patients with pulmonary infection after standardized treatment. Conclusion the neurological deficit score of NIH is high, and the nutritional status is poor. The patients with swallowing dysfunction, massive cerebral infarction and multi-focal infarction are prone to pulmonary infection. It is an effective measure to detect the changes of body temperature and clinical signs, to diagnose pulmonary infection early and in time, and to use sensitive antibacterial drugs.
【作者单位】：苏州大学附属第二医院神经内科;
【基金】：国家自然科学青年基金项目(81200894) 苏州市卫生局科教兴卫青年科技项目(KJXW2011017)
【分类号】：R563.1

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