丑晓华 高杏 刘天雅 王凤珍 韩强 张贤成

[摘要] 目的 分析徐州醫科大学附属医院（以下简称“我院”）神经内科重症监护病房（NICU）住院患者卒中相关性肺炎的危险因素与病原学特点，为其抗感染治疗药物选择提供依据。 方法 收集2016年1月～2017年6月我院收治的154例卒中患者归档病历，采用多因素Logistic回归分析卒中相关性肺炎的危险因素、主要的致病菌及其耐药性，并分析针对主要致病菌如何进行有效的抗感染治疗。 结果 多因素回归分析显示，年龄≥65岁、糖尿病、吞咽障碍、入院时血糖水平、血浆蛋白水平与白细胞计数水平等几个因素存在显著性差异（P < 0.05）。致病菌以革兰阴性（G-）菌为主占59.09%，前3位的主要致病菌分别为肺炎克雷伯菌、金黄色葡萄球菌与铜绿假单胞菌，主要致病菌存在严重的多重耐药现象，G-菌对替加环素、阿米卡星等较为敏感，金黄色葡萄球菌对万古霉素、利奈唑安、替加环素、阿米卡星、复方新诺明等较为敏感。 结论 我院NICU中卒中相关性肺炎的危险因素包括高龄、糖尿病、吞咽障碍、高血糖、低蛋白血症与高白细胞水平等。致病菌以G-菌为主，主要致病菌耐药性严重，抗感染治疗上可以优先选用阿米卡星、替加环素，考虑为耐甲氧西林金黄色葡萄球菌（MRSA）感染还可选择万古霉素、利奈唑安等抗菌药物。

[关键词] 神经内科重症监护病房；卒中相关性肺炎；危险因素；病原学特点；抗感染治疗

[中图分类号] R743.3 [文献标识码] A [文章编号] 1673-7210（2018）05（c）-0178-04

Analysis on the risk factors and anti-infective treatment of stroke-associated pneumonia in NICU in our hospital

CHOU Xiaohua1 GAO Xing1 LIU Tianya1 WANG Fengzhen1 HAN Qiang1 ZHANG Xiancheng2

1.Department of Pharmacy， Affiliated Hospital of Xuzhou Medical University， Jiangsu Province， Xuzhou 221006， China； 2.School of Pharmacy， Xuzhou Medical University， Jiangsu Province， Xuzhou 221004， China

[Abstract] Objective To analyze the risk factors and pathogens characteristics of stroke-associated pneumonia in neurological intensive care unit （NICU） of Affiliated Hospital of Xuzhou Medical University （"our hospital" for short）， so as to provide evidence for antimicrobial drug choice. Methods Clinical data of 154 patients with stroke from January 2016 to June 2017 in our hospital. The multivariate Logistic regression analysis was used to analyze the risk factors of stroke-associated pneumonia， and the main pathogenic bacteria and drug resistance statistically. It was studied that how to carry out effective anti-infective therapy on the main pathogens. Results Multivariate regression analysis showed significant differences （P < 0.05） in several factors such as age≥65 years， diabetes， dysphagia， hyperglycemia，hypoproteinemia，and high leukocyte count. The main pathogens were G- bacteria 59.09% in proportion， the top three major pathogens were Klebsiella pneumoniae， Staphylococcus aureus and Pseudomonas aeruginosa. The main pathogens showed severe multidrug resistance. G- bacteria were more sensitive to Tigecycline， Amikacin and so on. Staphylococcus aureus was more sensitive to Vancomycin， Linezolid， Tigecycline， Amikacin and Cotrimoxazole. Conclusion Risk factors of stroke-associated pneumonia in NICU of our hospital include advanced age， diabetes， dysphagia， hyperglycemia， hypoproteinemia， and high leukocyte count， etc. G- bacteria were the main pathogens. The main pathogens show severe multidrug resistance. Amikacin， Tigecycline can be used as the preferred antibacterial drugs， MRSA infection can also choose Vancomycin， Linezolid and other antibacterial drugs.

[Key words] Neurology intensive care unit； Stroke-associated pneumonia； Risk factors； Etiological characteristics； Anti-infective treatment

脑卒中，也可以称作脑血管意外，是人类第二大死亡原因[1]。感染是脑卒中后的常见并发症，可明显增加患者的死亡率，在众多感染中以肺部感染居多[2-3]。2003年，德国Hiker等[4]提出了卒中相关性肺炎（SAP）的相关概念，即原无肺部感染的卒中患者罹患感染性肺实质性炎症。SAP可以使患者的病情恶化，医疗费用增加[5]。因此SAP的早期预防和治疗对改善患者的预后、降低医疗成本尤为重要。以往的研究多以神经内科普通病房为研究对象，对神经内科重症监护病房（NICU）的研究不多[6]。因此，本文回顾性分析徐州医科大学附属医院（以下简称“我院”）NICU 154例脑卒中患者的病历资料，研究SAP在我院NICU中的发生率、危险因素、主要的致病菌与耐药性，以期为临床抗感染治疗药物选择提供参考。……