摘要目的 分析重症监护病房(ICU)急性自发性脑出血(sICH)患者医院获得性肺炎(HAP)的危险因素及病原菌分布,为防治该类患者肺部感染提供理论依据.方法 连续收集2015年1月至2017年2月入住ICU的sICH患者的临床资料,根据是否发生HAP分为感染组及未感染组.采用多因素Logistic回归探讨HAP发生的易感因素,并对感染患者的病原菌分布和药敏试验进行分析.结果 共有110例患者纳入研究,其中66例发生HAP,发生率为60.0％.多因素Logistic回归分析发现机械通气时间长(OR=1.028,95％CI1.012～1.044,P＜0.01)、格拉斯哥昏迷评分(GCS)评分低(OR=1.550,95％ CI1.148～2.093,P＜0.01)、住院总时间长(OR =1.131,95％CI 1.046～1.224,P＜0.01)及基础疾病≥2种(OR=9.793,95％CI 1.012 ～ 1.044,P＜0.01)是HAP发生的独立危险因素,而高水平血浆白蛋白(OR=0.897,95％ CI0.811 ～0.992,P＜0.05)是预防HAP发生的保护因素.66例患者共分离出病原菌183株,居前4位的依次是鲍曼不动杆菌(28.96％,53/183)、肺炎克雷伯菌(15.85％,29/183)、铜绿假单胞菌(13.11％,24/183)和金黄色葡萄球菌(12.02％,22/183).鲍曼不动杆菌、肺炎克雷伯菌和铜绿假单胞菌对大多数抗菌药物的耐药性较高,部分可达100.00％.金黄色葡萄球菌对大环内酯类、氟喹诺酮类和β-内酰胺类抗菌药均表现出较高的耐药性.结论 入住ICU的sICH患者HAP发生率高,病原菌以革兰阴性菌为主.临床上应针对该类患者采取有效的防治措施,并减少耐药菌株的产生.

abstractsObjective To analyze the pathogenic features and risk factors of hospital-acquired pneumonia in patients with acute spontaneous intracerebral hemorrhage (sICH) in intensive care unit (ICU).Methods The clinical data of 110 patients with sICH admitted in ICU during January 2015 and February 2017 were collected.Patients were divided into hospital-acquired pneumonia group (HAP group,n =66) and non-HAP group (n =44).Multivariate Logistic regression was used to study the risk factors of HAP,and pathogen distribution and drug susceptibility were analyzed.Results Multivariate Logistic regression demonstrated that long-term mechanical ventilation (OR =1.028,95％ CI 1.012-1.044,P ＜ 0.01),lower score of glasgow coma scale (GCS) (OR =1.550,95％ CI 1.148-2.093,P ＜ 0.01),prolonged hospital stay (OR =1.131,95％ CI 1.046-1.224,P ＜0.01) and underlying diseases more than two forms (OR =9.793,95％ CI 1.012-1.044,P ＜ 0.01) were the independent risk factors of HAP,while high plasma albumin level was protective factor for HAP (OR =0.897,95％ CI O.811-0.992,P ＜ 0.05).One hundred and eighty-three bacterial strains were isolated from 66 patients,the top 4 pathogens were Acinetobacter baumannii (28.96％,53/183),Klebsiella pneumonia (15.85％,29/183),Pseudomonas aeruginosa (13.11％,24/183) and Staphylococcus aureus (12.02％,22/183).Acinetobacter baumannii,Klebsiella pneumoniae and Pseudomonas aeruginosa were highly resistant to the majority of antibiotics,some of which even reached 100％.Staphylococcus aureus showed high resistance to macrolides,fluoroquinolones and β-lactam antibiotics.Conclusions There is high incidence of HAP in patients with sICH,and the pathogenic bacteria are mainly gram-negative bacteria.Effective prevention and treatment measures should be taken to reduce the incidence of HAP for patients with sICH in ICU.