急性脑卒中并发肺部感染的易感因素及病原学分析

目的了解急性脑卒中并发肺部感染的特点及危险因素．以便采取有效控制措施。方法对内江市第一人民医院2000年至2005年出院的急性脑卒中并发肺部感染患者进行回顾性调查分析。结果678例急性脑卒中并发肺部感染139例．感染率为20．5％。病原菌以G^-菌为主（62．3％）．其次为G^＋菌（19．4％）和真菌（18．3％）。G^-菌中以大肠埃希菌和铜绿假单胞菌为主．G^＋菌中以金黄色葡萄球菌为主．体外药敏显示G^-杆菌对亚胺培南、头孢派酮／舒巴坦较敏感。G^＋对万古霉素、替考拉宁和利福平等较敏感．真菌对两性霉素、5-氟胞嘧啶和制霉菌素较敏感。感染与患者年龄、住院时间、意识障碍、脑出血量、假性延髓麻痹、侵袭性操作及抗生素的不合理使用等有关。结论肺部感染是急性患者的重要危险因素．是造成病情加重及死亡的主要原因。临床应该护理到位。加强对细菌耐药性监测，合理使用抗生素。

Analysis on predisposing factors and pathogens of Brain stroke combined with lung infection

Objective To understand the features and risk factors of Brain stroke combined(BSC) with lung infection so as to adopt effective measure.Methods 139 cases of brain combined with lung infection from May 2000 to May 2005 were made a retrospectively investigative analysis.Results Of 678 cases of acute brain stroke,139 combined with pulmonary infection,the rate of infection was 20.5%.The pathogens showed that 62.3% were gram negative(G~-) bacteria,19.4% were gram positive(G~+) bacterial and 18.3% were fungi.G~-bacteria mainly included Escherichia coli and Pseudomonas aeruginosa,G~+bacteria mainly included Staphylococcus aureus.The most Gram-negative bacilli were highly susceptible to Imipenem,Cefoperazone/sulbactam,Gram-positive bacilli were highly susceptible to Teicoplanin and Vancomycin,fungi were highly susceptible to Amphotericn B and 5-Flucytcin.Nosocomial infection in patients with BSC was related to age,treatment days in hospita,disturbance of consciousness,quantity of hemorrhage,coma pseudo bulbar palsy,invasive operation and irrational use of bacteriophage.Conclusion Lung infection was the main risk factors of brain stroke combined.It was also the main cause leading to brain stroke combined aggravation and death. So there was a urgent need for surveillance of bacterial resistance and reasonable use of antibiotic.