Clinical Analysis Of 132 Cases Of Stroke-associated Pneumonia

Object To explore the infection and mortality of SAP,and the important factors influencing the development of SAP.The types of pathogens were analyzed.Methods A total of 1324 stroke patients were enrolled in the General Hospital of Ningxia Medical University from September 2014 to September 2015,including 1059 patients with cerebral infarction and 265 patients with cerebral hemorrhage to understand the infection of brain SAP in our hospital.Chose 132 patients with stroke associated pneumonia as SAP group,and 132 patients without stroke associated pneumonia as non SAP group.Then observed aspects of patients as follow: basic information(age,gender),past information(including diabetes,heart disease,chronic lung disease,history of stroke,history of smoking),clinical symptoms {including NIHSS score(NIHSS),dysphagia,disturbance of consciousness},post-admission treatment such as nasal feeding,antacid(Proton pump inhibitors,PPIs)and H2 receptor blockers(H2Ras),Use of dehydrating agent} and other circumstances(hospital costs,hospital days)for analysis.All the data were taken by SPSS19.0.The quantitative data were analyzed by t test,and the factors influencing the occurrence of SAP(test level ?= 0.05)were screened by ?2 test.And then logistic regression of the above factors;at the same time,sort out the distribution of pathogens in sputum culture.Binary logistic regressionanalysis derived from age,nasal feeding,using dehydrating agents,NIHSS score may be independent of SAP risk factors when p<0.05.At the same time,the distribution of pathogenic bacteria in sputum culture was sorted out.Results 1.The incidence of SAP was 9.97%,of which 87 cases were cerebral infarction,65.9% of SAP group and 45 cases of cerebral hemorrhage,accounting for 34.1% of SAP group.The total number of patients with stroke was10,the mortality rate was 0.76%,the death rate of SAP group was 5,the mortality rate was 3.79%,the reasons were brain stem failure(2 cases),hernia(1 case)Pneumonia,respiratory failure(1 case)and multiple organ failure(1 case);death rate was 0% in non-SAP group,and there was no significant difference between the two groups(?2 = 3.262,P> 0.05).2.The average length of hospital stay and cost of the SAP group were significantly higher than those of the non-SAP group(P<0.05).3.There were significant differences in age,sex,stroke type,heart disease,NIHSS score,disturbance of consciousness,difficulty in swallowing,antacid agent,dehydrating agent and indwelling gastric tube in univariate analysis(P<0.05).4.Binary logistic regression,derived from age,nasal feeding,using dehydrating agents,NIHSS score may be independent of SAP risk factors.5.SAP group of 132 patients were sent to sputum culture in 59 cases(44.7%),were sent to the sputum culture specimens 165 cases,18 kinds of pathogens were cultured,44 strains were detected in 101 cases,the detection rate was 76.52% Among them,88.64% were Gram-negative bacteria,namely,Acinetobacter baumannii,Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa and Haemophilus influenzae,respectively.Gram-positive cocci accounted for 4.55%;Fungi accounted for6.82%.6.Pathogens and their susceptibility to commonly used antibiotics size:Acinetobacter baumannii sensitive antibiotics for the combination of neomycin,minocycline,imipenem,etc.;Escherichia coli sensitive antimicrobial drugs foramikacin,Cefotetan,imipenem,etc.;pneumonia Klebsiella sensitive antibiotics for imipenem,levofloxacin,ceftazidime,etc.;Pseudomonas aeruginosa sensitive antimicrobial agents are amikacin,imipenem,Levofloxacin,etc.;Staphylococcus aureus sensitive antibiotics are Kaolinin,vancomycin,moxifloxacin and so on.Conclusion:1.Age(?65 years),NIHSS score(?10 scores)may be an independent risk factor for SAP.2.Streptococcal pneumonia in patients with sputum culture pathogens are mostly Gram-negative bacilli,including Acinetobacter baumannii,Escherichia coli and other;Gram-positive bacteria to Staphylococcus aureus,fungal Candida albicans the Lord.