老年非瓣膜性房颤伴急性脑梗死患者肺部感染的临床特点分析
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摘要
目的探究老年非瓣膜性房颤(NVAF)伴急性脑梗死患者合并肺部感染的临床特点及影响因素。方法收集2015年4月-2017年6月医院收治的244例NVAF伴急性脑梗死患者的临床病例资料,对患者的一般资料、实验室检查、影像学检查、病原菌分析结果等进行分析。结果感染组与非感染组临床资料比较:患者年龄、病程、NIHSS评分差异具有统计学意义(P<0.05);病原菌分析结果显示感染以细菌为主,多为革兰阴性菌,前三位的病原体为大肠埃希菌、金黄色葡萄球菌、肺炎克雷伯菌;37例肺部感染患者病变主要位于右肺下叶,占32.43%,感染患者的肺损害以单纯浸润性病变为主,占62.16%;实验室检查结果显示中性粒细胞百分比、清蛋白、球蛋白、CRP差异具有统计学意义(P<0.05)。结论老年NVAF伴急性脑梗死患者合并肺部感染的病原菌以革兰阴性菌感染为主,高龄、病程长、神经功能缺损严重、清蛋白降低、球蛋白减少、CRP增高是NVAF伴急性脑梗死患者肺部感染的易感因素。
OBJECTIVE To explore the clinical characteristics and influencing factors for pulmonary infection in the elderly nonvalvular atrial fibrillation(NVAF)patients complicated with acute cerebral infarction.METHODS The clinical data were collected from 244 NVAF patients complicated with acute cerebral infarction who were treated in the hospital from Apr 2015 to Jun 2017.The baseline data and results of laboratory examination,imageological examination and etiological test were observed.RESULTS As compared with the clinical data,there were significant differences in the age,disease course and NIHSS score between the infection group and the non-infection group(P<0.05).The result of etiological test showed that the patients with bacterial infection were dominant,the gramnegative bacteria were the predominant pathogens,and Escherichia coli,Staphylococcus aureus and Klebsiella pneumoniae ranked the top 3 species of pathogens.Among 37 patients with pulmonary infection,the patients with lesions located in the lower lobe of right lung accounted for 62.16%.The result of laboratory examination indicated that there were significant differences in the percentage of neutrophils,albumin,globulin and CRP(P<0.05).CONCLUSIONThe gram-negative bacteria are dominant among the pathogens causing pulmonary infection in the elderly NVAF patients complicated with acute cerebral infarction.The advanced age,long disease course,severe neurologic impairment,decrease of albumin level,decrease of globulin level and increase of CRP level are the predisposing factors for the pulmonary infection in the NVAF patients complicated with acute cerebral infarction.
OBJECTIVE To explore the clinical characteristics and influencing factors for pulmonary infection in the elderly nonvalvular atrial fibrillation(NVAF)patients complicated with acute cerebral infarction.METHODS The clinical data were collected from 244 NVAF patients complicated with acute cerebral infarction who were treated in the hospital from Apr 2015 to Jun 2017.The baseline data and results of laboratory examination,imageological examination and etiological test were observed.RESULTS As compared with the clinical data,there were significant differences in the age,disease course and NIHSS score between the infection group and the non-infection group(P<0.05).The result of etiological test showed that the patients with bacterial infection were dominant,the gramnegative bacteria were the predominant pathogens,and Escherichia coli,Staphylococcus aureus and Klebsiella pneumoniae ranked the top 3 species of pathogens.Among 37 patients with pulmonary infection,the patients with lesions located in the lower lobe of right lung accounted for 62.16%.The result of laboratory examination indicated that there were significant differences in the percentage of neutrophils,albumin,globulin and CRP(P<0.05).CONCLUSIONThe gram-negative bacteria are dominant among the pathogens causing pulmonary infection in the elderly NVAF patients complicated with acute cerebral infarction.The advanced age,long disease course,severe neurologic impairment,decrease of albumin level,decrease of globulin level and increase of CRP level are the predisposing factors for the pulmonary infection in the NVAF patients complicated with acute cerebral infarction.
引文
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[10]范怀海.阿米卡星治疗ICU病房中肺部感染的疗效观察[J].转化医学电子杂志,2015,2(9):6-7.
[11]Graham DJ,Reichman ME,Wernecke M,et al.Cardiovascular,bleeding,and mortality risks in elderly Medicare patients treated with dabigatranor warfarin for nonvalvular atrial fibrillation[J].Circulation,2015,131(2):157-164.
[2]黄琳,燕兰云,吴婷,等.不同年龄段非瓣膜性房颤患者防治脑梗死的用药情况比较[J].中国现代医学杂志,2015,25(34):23-26.
[3]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[4]王一尘.心房颤动的诊断与治疗[J].中国综合临床,2009,25(9):1006-1008.
[5]Brott T,Marler JR,Olinger CP,et al.Measurements of acute cerebral infarction:lesion size by computed tomography[J].Stroke,1989,20(7):871-875.
[6]尚红,王毓三,申子瑜.全国临床检验操作规程[M].人民卫生出版社,2015:624-657.
[7]孙军,汪宁,温昌明,等.影响脑梗死患者伴发心律失常-房颤的影响因素分析[J].中国现代医学杂志,2017,27(10):131-135.
[8]Milling TJ,Fromm C,Ganetsky M,et al.Management of major bleeding events in patients treated with dabigatran for nonvalvular atrial fibrillation:a retrospective,multicenter review[J].Ann Emerg Med,2017,69(5):531-540.
[9]Alberts MJ,Peacock WF,Fields LE,et al.Association between once-and twice-daily direct oral anticoagulant adherence in nonvalvularatrial fibrillation patients and rates of ischemic stroke[J].Int J Cardiol,2016,215:11-13.
[10]范怀海.阿米卡星治疗ICU病房中肺部感染的疗效观察[J].转化医学电子杂志,2015,2(9):6-7.
[11]Graham DJ,Reichman ME,Wernecke M,et al.Cardiovascular,bleeding,and mortality risks in elderly Medicare patients treated with dabigatranor warfarin for nonvalvular atrial fibrillation[J].Circulation,2015,131(2):157-164.