老年急性脑梗死患者呼吸机相关性肺炎及影响因素分析

Characteristic and impact factors of ventilator-associated pneumonia in elderly patients with cerebral infarction

摘要:

分析老年急性脑梗死患者呼吸机相关性肺炎感染特点及影响因素，从而寻找针对性预防控制 措施。方法回顾性调查西南医科大学附属医院重症监护病房2013～2014年收治的机械通气>48 h的375 例 老年急性脑梗死患者，比较肺炎感染情况并分析影响因素。结果119 例患者发生呼吸机相关性肺炎，感染率 为31.73%。共分离病原菌175 株，其中革兰阴性杆菌115 株，占65.71%；革兰阳性球菌49 株，占28.00%；真菌 11 株，占6.29%。呼吸机应用时间长、平卧体位、应用镇静剂、胃内容物反流和误吸、APACHEⅡ评分高是引起感 染的危险因素。结论重症监护病房老年急性脑梗死患者呼吸机相关性肺炎感染较常见，多种因素促进感染 的发生。

Abstract:

To explore the clinical characteristics and impact factors of ventilator -associated pneumonia in elderly cerebral infarction patients so as to provide evidence for prevention and treatment. Methods A total of 375 elderly patients with acute cerebral infarction in the Intensive Care Unit (ICU) who received mechanical ventilation for over 48 hours from 2013 to 2014 were retrospectively studied. The pneumonia infection and impact factors were also investigated. Results A total of 119 cases (31.73%) suffered from ventilator-associated pneumonia. From the patients 175 strains of pathogens were isolated, including 115 strains of Gram-negative bacilli (65.71%),49 strains of Gram-positive bacilli (28.00%) and 11 strains of fungi (6.29%). Long time of ventilator application, supine position, usage of a sedative, reflux and aspiration of gastric contents and higher score of APACHEⅡwere the risk factors for ventilator-associated pneumonia. Conclusions Ventilator-associated pneumonia is very common in elderly patients with acute cerebral infarction in the Intensive Care Unit, and a variety of factors contribute to the occurrence of the infection.