中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
Chinese Journal of Emergency Medicine
2015年
9期
1004-1010
,共7页
钟明媚%王璠%张琳%彭松%张金%郝明伟
鐘明媚%王璠%張琳%彭鬆%張金%郝明偉
종명미%왕번%장림%팽송%장금%학명위
重症监护病房%卒中相关性肺炎%危险因素%病原菌
重癥鑑護病房%卒中相關性肺炎%危險因素%病原菌
중증감호병방%졸중상관성폐염%위험인소%병원균
Intensive care unit%Stroke associated pneumonia%Risk factors%Pathogen
目的 分析重症监护病房(ICU)中急性脑卒中患者伴发卒中相关性肺炎(SAP)的发生率、危险因素及病原学特点.方法 回顾性分析2012年1月至2013年12月合肥市第一人民医院综合ICU收治的142例脑卒中患者的临床资料,分析其基本资料、脑卒中情况、基础疾病、治疗情况、预后及感染病原菌,分别通过成组t检验、Mann-Whitney U检验、Pearson x2检验和多因素Logistic回归模型对SAP的发生风险进行单因素和多因素分析.结果 142例脑卒中患者发生SAP共94例,发生率为66.2％,其中54.3％为早发性肺炎.94例SAP患者菌群分析结果显示早发性肺炎组的致病菌主要为金黄色葡萄球菌和肺炎克雷伯杆菌;晚发性肺炎组致病菌以鲍曼不动杆菌、金黄色葡萄球菌和铜绿假单胞菌为主.多因素Logistic回归分析显示脑出血(OR=10.917,95％ CI:1.834～60.959)、既往卒中史(OR=15.223,95％ CI:1.947 ～ 96.969)、入科时高APACHEⅡ评分(OR=1.607,95％ CI:1.253 ～2.062)、存在吞咽障碍(OR=5.321,95％ CI:1.225 ～ 26.519)、机械通气时间长(OR=1.809,95％ CI:1.208～2.709)、ICU住院时间长(OR=1.391,95％CI:1.085～1.783)以及高血糖(OR=1.534,95％CI:1.101～2.138)是ICU中SAP发生的独立危险因素,血浆白蛋白水平与SAP的发生呈负相关(OR=0.809,95％ CI:0.674 ～0.971).对SAP中早发性肺炎(EOP)和晚发性肺炎(LOP)分别分析,发现其共同危险因素为APACHEⅡ评分和机械通气时间,EOP的危险因素还有存在吞咽障碍(OR =4.331,95％CI:1.330～14.098)、既往卒中史(OR=13.690,95％CI:2.198～ 85.277)以及慢性支气管炎(OR=12.907,95％CI:1.203～138.542),LOP的危险因素还有ICU住院时间长(OR=1.687,95％CI:1.131～2.517)、脑出血(OR=21.657,95％CI:1.559～ 106.752),血浆白蛋白水平是LOP的保护因素(OR=0.782,95％CI:0.637 ～0.961).EOP组与LOP组间病死率(49.0％vs.44.2％)差异无统计学意义(P＞0.05),但明显高于非SAP组.结论 ICU中SAP发生率高,病死率高,针对SAP发生的相关危险因素,积极采取综合性预防措施是降低其发生率的关键.
目的 分析重癥鑑護病房(ICU)中急性腦卒中患者伴髮卒中相關性肺炎(SAP)的髮生率、危險因素及病原學特點.方法 迴顧性分析2012年1月至2013年12月閤肥市第一人民醫院綜閤ICU收治的142例腦卒中患者的臨床資料,分析其基本資料、腦卒中情況、基礎疾病、治療情況、預後及感染病原菌,分彆通過成組t檢驗、Mann-Whitney U檢驗、Pearson x2檢驗和多因素Logistic迴歸模型對SAP的髮生風險進行單因素和多因素分析.結果 142例腦卒中患者髮生SAP共94例,髮生率為66.2％,其中54.3％為早髮性肺炎.94例SAP患者菌群分析結果顯示早髮性肺炎組的緻病菌主要為金黃色葡萄毬菌和肺炎剋雷伯桿菌;晚髮性肺炎組緻病菌以鮑曼不動桿菌、金黃色葡萄毬菌和銅綠假單胞菌為主.多因素Logistic迴歸分析顯示腦齣血(OR=10.917,95％ CI:1.834～60.959)、既往卒中史(OR=15.223,95％ CI:1.947 ～ 96.969)、入科時高APACHEⅡ評分(OR=1.607,95％ CI:1.253 ～2.062)、存在吞嚥障礙(OR=5.321,95％ CI:1.225 ～ 26.519)、機械通氣時間長(OR=1.809,95％ CI:1.208～2.709)、ICU住院時間長(OR=1.391,95％CI:1.085～1.783)以及高血糖(OR=1.534,95％CI:1.101～2.138)是ICU中SAP髮生的獨立危險因素,血漿白蛋白水平與SAP的髮生呈負相關(OR=0.809,95％ CI:0.674 ～0.971).對SAP中早髮性肺炎(EOP)和晚髮性肺炎(LOP)分彆分析,髮現其共同危險因素為APACHEⅡ評分和機械通氣時間,EOP的危險因素還有存在吞嚥障礙(OR =4.331,95％CI:1.330～14.098)、既往卒中史(OR=13.690,95％CI:2.198～ 85.277)以及慢性支氣管炎(OR=12.907,95％CI:1.203～138.542),LOP的危險因素還有ICU住院時間長(OR=1.687,95％CI:1.131～2.517)、腦齣血(OR=21.657,95％CI:1.559～ 106.752),血漿白蛋白水平是LOP的保護因素(OR=0.782,95％CI:0.637 ～0.961).EOP組與LOP組間病死率(49.0％vs.44.2％)差異無統計學意義(P＞0.05),但明顯高于非SAP組.結論 ICU中SAP髮生率高,病死率高,針對SAP髮生的相關危險因素,積極採取綜閤性預防措施是降低其髮生率的關鍵.
목적 분석중증감호병방(ICU)중급성뇌졸중환자반발졸중상관성폐염(SAP)적발생솔、위험인소급병원학특점.방법 회고성분석2012년1월지2013년12월합비시제일인민의원종합ICU수치적142례뇌졸중환자적림상자료,분석기기본자료、뇌졸중정황、기출질병、치료정황、예후급감염병원균,분별통과성조t검험、Mann-Whitney U검험、Pearson x2검험화다인소Logistic회귀모형대SAP적발생풍험진행단인소화다인소분석.결과 142례뇌졸중환자발생SAP공94례,발생솔위66.2％,기중54.3％위조발성폐염.94례SAP환자균군분석결과현시조발성폐염조적치병균주요위금황색포도구균화폐염극뢰백간균;만발성폐염조치병균이포만불동간균、금황색포도구균화동록가단포균위주.다인소Logistic회귀분석현시뇌출혈(OR=10.917,95％ CI:1.834～60.959)、기왕졸중사(OR=15.223,95％ CI:1.947 ～ 96.969)、입과시고APACHEⅡ평분(OR=1.607,95％ CI:1.253 ～2.062)、존재탄인장애(OR=5.321,95％ CI:1.225 ～ 26.519)、궤계통기시간장(OR=1.809,95％ CI:1.208～2.709)、ICU주원시간장(OR=1.391,95％CI:1.085～1.783)이급고혈당(OR=1.534,95％CI:1.101～2.138)시ICU중SAP발생적독립위험인소,혈장백단백수평여SAP적발생정부상관(OR=0.809,95％ CI:0.674 ～0.971).대SAP중조발성폐염(EOP)화만발성폐염(LOP)분별분석,발현기공동위험인소위APACHEⅡ평분화궤계통기시간,EOP적위험인소환유존재탄인장애(OR =4.331,95％CI:1.330～14.098)、기왕졸중사(OR=13.690,95％CI:2.198～ 85.277)이급만성지기관염(OR=12.907,95％CI:1.203～138.542),LOP적위험인소환유ICU주원시간장(OR=1.687,95％CI:1.131～2.517)、뇌출혈(OR=21.657,95％CI:1.559～ 106.752),혈장백단백수평시LOP적보호인소(OR=0.782,95％CI:0.637 ～0.961).EOP조여LOP조간병사솔(49.0％vs.44.2％)차이무통계학의의(P＞0.05),단명현고우비SAP조.결론 ICU중SAP발생솔고,병사솔고,침대SAP발생적상관위험인소,적겁채취종합성예방조시시강저기발생솔적관건.
Objective To analyze the incidence,risk factors and pathogens of stroke associated pneumonia (SAP) in patients with acute stroke in the intensive care unit (ICU).Methods One hundred and forty-two patients with acute stroke admitted in ICU from January 2012 to December 2013 were retrospectively studied.The data of medical history of patients,treatment,prognosis,and pathogens of SAP were collected.Data were analyzed by t test,Mann-Whitney U test,Pearson x2 test and muhivariable logistic regression.Results Of 142 patients,94 (66.2％) were contracted SAP of which 54.3％ were early-onset pneumonia (EOP≤72 h) and 45.7％ were late-onset pneumonia (LOP ＞72 h).The most common pathogens isolated from EOP were Staphylococcus aureus and Klebsiella pneumonia,while the most common pathogens isolated from LOP were Acinetobacter baumanii,Staphylococcus aureus and Pseudomonas aeruginosa.Multivariate logistic regression analysis demonstrated that hemorrhagic apoplexy,history of stroke,higher APACHE score,dysphagia,prolonged use of mechanical ventilation,prolonged stay in ICU,and hyperglycemia were the independent risk factors of SAP,and the odds ratios (OR) with 95％ confidence intervals (CI) were 10.917 (1.834-60.959),15.223 (1.947-96.969),1.607 (1.253-2.062),5.321 (1.225-26.519),1.809 (1.208-2.709),1.391 (1.085-1.783),1.534 (1.l01-2.138),respectively.While plasma albumin level was negatively associated with SAP (OR =0.809,95％ CI:0.674-0.971).The common risk factors of EOP and LOP were higher APACHE score and prolonged use of of mechanical ventilation.The independent risk factors of EOP were dysphagia (OR =4.331,95％ CI:1.330-14.098),history of stroke (OR =13.690,95％ CI:2.198-85.277) and chronic bronchitis (OR =12.907,95％ CI:1.203-138.542),While those of LOP were prolonged stay in ICU (OR =1.687,95 ％ CI:1.131-2.517),hemorrhagic apoplexy (OR =21.657,95％ CI:1.559-106.752) and low plasma albumin level (OR =0.782,95％ CI:0.637-0.961).There was no significant difference in mortality between EOP (49％) and LOP (44.2％) (P ＞ 0.05),but the mortality of SAP was significantly higher than that of non-SAP group.Conclusions The incidence rate and mortality of SAP are quite high in ICU.The pathogens and risk factors are different between EOP and LOP.This observation results suggest it is important to identify high-risk stroke patients,and to develop a novel treatment strategy and prophylactic measures facilitating limiting the complications of stroke.
