CAJ | 학술논문

目的：分析脑卒中相关性肺炎(SAP )的相关危险因素，并观察其临床特点。方法收集该院神经内科2009年1月—2013年1月收治的150例脑卒中患者的资料,其中35例发作为SAP组,115例未发生SAP作为非SAP组,对两组患者年龄、性别、糖尿病、房颤、卒中类型、意识障碍、气管插管∕切开、呼吸机使用、吞咽困难等临床资料进行统计分析,观察其与SAP发生的关系,同时观察对SAP患者进行痰培养并进行药敏试验的结果。结果单因素及多因素Logistic分析显示：年龄、糖尿病、房颤致大面积脑梗死、卒中后球肌麻痹（吞咽困难）、气管插管/切开、呼吸机使用等均为SAP发病的高危因素。 SAP患者中共培养出菌株20例，主要以痰培养为主，革兰氏阴性杆菌为主要的条件致病菌，包括肺炎克雷伯杆菌(30.00%）、大肠埃希菌(15.00%）、铜绿假单胞菌(15.00%)。金黄色葡萄球菌(25.00%）也不少见，其他如肺炎链球菌及致病性真菌感染相对少见。结果显示其中药敏革兰阴性杆菌对舒巴坦/头孢哌酮保持较高的敏感性,革兰阳性菌对万古霉素最为敏感，耐药性低。结论 SAP的相关危险因素较多,临床上应引起重视并尽早采取合理的治疗和干预措施,对防治相关性肺炎的发生具有重要意义。
목적：분석뇌졸중상관성폐염(SAP )적상관위험인소，병관찰기림상특점。방법수집해원신경내과2009년1월—2013년1월수치적150례뇌졸중환자적자료,기중35례발작위SAP조,115례미발생SAP작위비SAP조,대량조환자년령、성별、당뇨병、방전、졸중류형、의식장애、기관삽관∕절개、호흡궤사용、탄인곤난등림상자료진행통계분석,관찰기여SAP발생적관계,동시관찰대SAP환자진행담배양병진행약민시험적결과。결과단인소급다인소Logistic분석현시：년령、당뇨병、방전치대면적뇌경사、졸중후구기마비（탄인곤난）、기관삽관/절개、호흡궤사용등균위SAP발병적고위인소。 SAP환자중공배양출균주20례，주요이담배양위주，혁란씨음성간균위주요적조건치병균，포괄폐염극뢰백간균(30.00%）、대장애희균(15.00%）、동록가단포균(15.00%)。금황색포도구균(25.00%）야불소견，기타여폐염련구균급치병성진균감염상대소견。결과현시기중약민혁란음성간균대서파탄/두포고동보지교고적민감성,혁란양성균대만고매소최위민감，내약성저。결론 SAP적상관위험인소교다,림상상응인기중시병진조채취합리적치료화간예조시,대방치상관성폐염적발생구유중요의의。
Objective To analyze the relevant risk factors of stroke associated pneumonia (SAP) and observe its clinical character-istics. Methods The clinical data of 150 stroke patients admitted into the Department of Neurology of our hospital from January, 2009 to January, 2013 were collected. Among them, 35 cases occurred SAP were categorized into the SAP group, the rest cases without SAP were selected as the non-SAP group (n=115). The clinical data like age, gender, diabetes mellitus, atrial fibrillation, stroke type, disturbance of consciousness, trachea cannula or tracheal incision, ventilator supporting and stroke-associated dyspha-gia, and so on were statistically analyzed in both groups aiming at finding out their relations with the occurrence of SAP. Sputum culture and drug sensitive test in SAP patients were performed, and the results were observed. Results Single and multiple factor logistic analysis indicated that age, diabetes mellitus, atrial fibrillation-related mass cerebral infarct, stroke associated-dysphagia, trachea cannula or tracheal incision, ventilator supporting and disturbance of consciousness were all risk factors leading to the oc-currence of SAP. A total of 20 strains of bacteria were mainly isolated from the sputum culture of the SAP patients. Gram negative bacilli were the main pathogens including Klebsiella pneumonia (30.00%) Escherichia coli (15.00%), Pseudomonas aeruginosa (15.00%). And Staphylococcus aureus(25.00%) were commonly seen bacteria accounting in SAP. Others like Streptococcus pneu-monia and fungus infection were rarely occurred. Outcome of drug sensitive test indicated Gram-negative bacilli kept higher sensi-tive to Cefoperazone-Sulbactam. Gram-positive bacilli were extremely sensitive to Vancomycin with low resistance. Conclusion There are a number of relevant risk factors of SAP deserving to be paid great attention and taken rational treatment and interven-tion measures as early as possible, which is significant in preventing the occurrence of associated pneumonia.