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目的:探讨脑出血患者医院获得性肺炎(HP)的相关危险因素及其病原学特点。方法:回顾分析我院2011年1月-2013年12月脑出血患者208例的临床资料,根据有无并发HP分为A组和B组,比较两组患者的性别、年龄、基础疾病、病情,A组的病原菌种类及其耐药率。结果:本组脑出血患者HP发病率为25.0%。年龄≥65岁,基础疾病≥2种,合并糖尿病、慢性阻塞性肺疾病(COPD),GSC评分<8,气管切开,鼻饲,吸痰和住院≥7 d是脑出血患者HP的高危因素。52例HP患者的下呼吸道分泌物标本中共分离出致病菌72株,其中革兰氏阴性菌49株(68.0%),革兰氏阳性菌19株(26.4%),真菌4株(5.6%)。革兰氏阴性菌以铜绿假单胞菌、肺炎克雷伯菌、嗜麦芽窄食单胞菌及大肠埃希菌为主;革兰氏阳性菌以金黄色葡萄球菌为主。铜绿假单胞菌和肺炎克雷伯菌对头孢菌类的耐药率高,对喹诺酮类药物的耐药率较低;金黄色葡萄球菌对青霉素、红霉素的耐药率高,对头孢菌类的耐药率低。结论:关注脑出血患者HP的高危因素,监测病原菌,合理使用抗生素。
Objective: To explore the related risk factors and etiological characteristics of hospital acquired pneumonia (HP) in patients with cerebral hemorrhage. Methods: The clinical data of 208 patients with ICH from January 2011 to December 2013 in our hospital were retrospectively analyzed. According to the presence or absence of HP, the patients were divided into A group and B group. The gender, age, underlying diseases, , A group of pathogenic bacteria and their resistance rate. Results: The incidence of HP in patients with cerebral hemorrhage was 25.0%. Age ≥ 65 years old, basic diseases ≥ 2 kinds, with diabetes, chronic obstructive pulmonary disease (COPD), GSC score <8, tracheotomy, nasal feeding, suctioning and hospitalization ≥ 7 d are risk factors for HP in patients with intracerebral hemorrhage. Of the 52 cases, 72 strains of pathogenic bacteria were isolated from lower respiratory secretions, of which, 49 (60.0%) were Gram-negative bacteria, 19 (26.4%) were Gram-positive bacteria and 4 ). Gram-negative bacteria Pseudomonas aeruginosa, Klebsiella pneumoniae, Stenotrophomonas maltophilia and Escherichia coli; Gram-positive Staphylococcus aureus-based. Pseudomonas aeruginosa and Klebsiella pneumoniae to cephalosporins resistance rate is high, quinolones resistance rate is low; Staphylococcus aureus penicillin, erythromycin high rate of resistance to cephalosporins The fungal resistance rate is low. Conclusion: Concerned about the high risk factors of cerebral hemorrhage in patients with HP, monitoring of pathogens, the rational use of antibiotics.