CAJ | 학술논문

目的：分析脑梗死并发卒中相关性肺炎（SAP）患者的菌群特点及其危险因素。方法选取2011年1月—2014年4月南京鼓楼医院集团仪征医院神经内科收治的275例脑梗死患者，按照是否并发 SAP 分为 SAP 组34例和非 SAP 组241例。对 SAP 组患者进行痰培养，收集所有脑梗死患者的临床资料，包括年龄、性别、既往史、意识障碍、延髓麻痹、脑梗死面积、脑梗死病灶数量、侵入性操作情况，分析脑梗死并发 SAP 的危险因素。结果 SAP 组患者痰培养结果示：革兰阴性菌感染18例，革兰阳性菌感染10例，混合感染5例，正常菌群1例。两组患者性别、高血压病史阳性率、脑梗死病灶数量比较，差异无统计学意义（P ﹥0.05）；两组患者年龄、糖尿病病史阳性率、肺部疾病史阳性率、意识障碍发生率、延髓麻痹发生率、大面积脑梗死发生率、侵入性操作率比较，差异有统计学意义（ P﹤0.05）。多因素 Logistic 回归分析结果显示，年龄≥65岁〔OR =4.430，95% CI（1.446，13.573）〕、意识障碍〔OR=3.586，95% CI（1.351，9.515）〕、延髓麻痹〔 OR =7.599，95% CI（1.966，29.370）〕、大面积脑梗死〔 OR =3.467，95% CI（1.083，11.099）〕、侵入性操作〔OR =3.464，95% CI（1.089，11.015）〕是脑梗死患者并发 SAP 的独立危险因素（P ﹤0.05）。结论脑梗死并发 SAP 患者的致病菌以革兰阴性菌为主，年龄≥65岁、意识障碍、延髓麻痹、大面积脑梗死、侵入性操作是脑梗死患者并发 SAP 的危险因素。
목적：분석뇌경사병발졸중상관성폐염（SAP）환자적균군특점급기위험인소。방법선취2011년1월—2014년4월남경고루의원집단의정의원신경내과수치적275례뇌경사환자，안조시부병발 SAP 분위 SAP 조34례화비 SAP 조241례。대 SAP 조환자진행담배양，수집소유뇌경사환자적림상자료，포괄년령、성별、기왕사、의식장애、연수마비、뇌경사면적、뇌경사병조수량、침입성조작정황，분석뇌경사병발 SAP 적위험인소。결과 SAP 조환자담배양결과시：혁란음성균감염18례，혁란양성균감염10례，혼합감염5례，정상균군1례。량조환자성별、고혈압병사양성솔、뇌경사병조수량비교，차이무통계학의의（P ﹥0.05）；량조환자년령、당뇨병병사양성솔、폐부질병사양성솔、의식장애발생솔、연수마비발생솔、대면적뇌경사발생솔、침입성조작솔비교，차이유통계학의의（ P﹤0.05）。다인소 Logistic 회귀분석결과현시，년령≥65세〔OR =4.430，95% CI（1.446，13.573）〕、의식장애〔OR=3.586，95% CI（1.351，9.515）〕、연수마비〔 OR =7.599，95% CI（1.966，29.370）〕、대면적뇌경사〔 OR =3.467，95% CI（1.083，11.099）〕、침입성조작〔OR =3.464，95% CI（1.089，11.015）〕시뇌경사환자병발 SAP 적독립위험인소（P ﹤0.05）。결론뇌경사병발 SAP 환자적치병균이혁란음성균위주，년령≥65세、의식장애、연수마비、대면적뇌경사、침입성조작시뇌경사환자병발 SAP 적위험인소。
Objective To analyze the bacterial characteristics and risk factors of stroke - associated pneumonia (SAP)in patients with cerebral infarction. Methods A total of 275 patients with cerebral infarction were selected in Yizheng Hospital of Nanjing Gulou Hospital Group from January 2011 to April 2014,and they were divided into A group(complicated with SAP,n = 34)and B group(did not complicated with SAP,n = 241) according to the incidence of SAP,patients of A group received sputum cultures. Clinical data of the the two groups were collected,including age,gender,past medical history, disorder of consciousness,central bulbar paralysis,cerebral infarct area,number of cerebral infarction lesions,incidence of invasive operations. Results Sputum cultures found that,there were 18 cases with gram - negative bacterial infections,10 cases with gram - positive bacterial infections,5 cases with mixed infections,1 cases with normal flora. No statistically significant differences of gender,positive rate of hypertension history or number of cerebral infarction lesions was found between the two groups(P ﹥ 0. 05);while there were statistically significant differences of age,positive rate of diabetes history,positive rate of pulmonary disease history,incidence of disorder of consciousness,incidence of central bulbar paralysis,incidence of massive cerebral infarction and incidence of invasive operations between the two groups( P ﹤ 0. 05). Multivariate Logistic regression analysis showed that,age equal or over 65 years old〔 OR = 4. 430,95% CI(1. 446,13. 573)〕,disorder of consciousness〔OR = 3. 586,95% CI(1. 351,9. 515)〕,central bulbar paralysis〔 OR = 7. 599,95% CI(1. 966,29. 370)〕,massive cerebral infarction 〔 OR = 3. 467,95% CI ( 1. 083,11. 099 )〕, invasive operations 〔 OR = 3. 464,95% CI ( 1. 089, 11. 015)〕were risk factors of SAP in patients with cerebral infarction. Conclusion Gram - negative bacteria are the main pathogens of SAP in patients with cerebral infarction,age equal or over 65 years old,disorder of consciousness,central bulbar paralysis,massive cerebral infarction,invasive operations are risk factors of SAP in patients with cerebral infarction.