脑卒中相关性肺炎多重耐药性感染危险因素及控制的措施.docVIP

脑卒中相关性肺炎多重耐药性感染危险因素及控制的措施 　　[摘要] 目的 了解?X卒中相关性肺炎多重耐药性感染的相关危险因素，并依据相关危险采取相关控制措施。 方法 选择2013年8月～2014年9月在湖南师范大学附属湘南医院住院治疗的急性脑卒中患者540例，对于脑卒中相关性肺炎（SAP）患者采集晨痰进行送检，了解其多重耐药性情况。利用单因素和多因素Logistic回归分析法对导致患者发生医院感染的相关危险因素进行分析。 结果 540例急性脑卒中患者，发生相关性肺炎的患者共89例，感染率为16.46%；89例SAP患者共分离出病原菌167株，其中多重耐药菌123株，革兰阴性菌占68.29%，以铜绿假单胞菌、肺炎克雷伯杆菌及鲍曼不动杆菌为主。革兰阳性菌占31.71%，以溶血性葡萄球菌、金黄色葡萄球菌为主；结果显示年龄≥50岁，住院时间≥30 d，合并糖尿病、意识障碍、低蛋白血症、机械通气及留置鼻饲管等相关侵入性操作是SAP多重耐药性发生的独立危险因素（P 0.05）。 结论 SAP的发病率在临床上相对较高，且发生SAP的患者病原菌分布主要以多重耐药菌为主，因此详细了解引起SAP多重耐药性的病原菌分布情况及发生风险的危险因素，采用针对性的预防措施有着重要意义。 　　[关键词] 脑卒中；相关性肺炎；多重耐药菌；危险因素 　　[中图分类号] R743 [文献标识码] A [文章编号] 1673-7210（2018）03（b）-0108-05 　　Risk factors and control measures of multidrug resistance in stroke - related pneumonia 　　LUO Ya1，2 LI Zhongqiu1 ZENG Meifang2 　　1.Department of Neurology， 169th Hospital of PLA Hu′nan Normal University Affiliated Xiangnan Hospital， Hu′nan Province， Hengyang 4210022， China； 2.Health Economics Office， 169th Hospital of PLA Hu′nan Normal University Affiliated Xiangnan Hospital， Hu′nan Province， Hengyang 4210022， China 　　[Abstract] Objective To understand the risk factors associated with multiple drug-resistant infections in stroke-associated pneumonia and to take relevant control measures based on the relevant risks. Methods A total of 540 acute stroke patients hospitalized from August 2013 to September 2014 in Hunan Normal University Affiliated Xiangnan Hospital were selected. Morning sputum was collected from patients with stroke-associated pneumonia for multi-drug resistance. Univariate and multivariate logistic analyzes were used to analyze the risk factors that led to hospital-acquired nosocomial infections. Results Among the 540 patients with acute stroke， 89 cases were associated with pneu monia and the infection rate was 16.46%. A total of 167 pathogenic bacteria were isolated from 89 stroke-associated pneumonia （SAP） patients， of which 123 were multi-drug resistant bacteria， and the gram-negative bacteria accounting for 68.29% with ps