脑梗死合并吸入性肺炎的危险因素及其护理对策
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摘要
目的分析导致脑梗死合并吸入性肺炎的相关危险因素,并探讨其护理对策。方法选择2015年4月至2018年1月在宝鸡市人民医院接受治疗的60例急性脑梗死患者作为研究对象。以32例已确诊为吸入性肺炎的患者为观察组,28例未确诊为吸入性肺炎的患者作为对照组。所有患者均给予优化的集束化护理,分析影响脑梗死患者吸入性肺炎的危险因素。结果观察组和对照组患者的误吸史(78.12%vs 35.71%)、老年痴呆(56.25%vs17.84%)、帕金森氏病(81.25%vs 7.14%)、脑卒中(75.00%vs 46.43%)、是否自主进食(84.38%vs 10.71%)以及饮酒患者(65.63%vs 28.60%)比较,观察组明显高于对照组,差异均有统计学意义(P<0.05)。观察组患者出现糖尿病、高血压、低白蛋白血症、吸烟以及尿肌酐水平升高的例数与对照组比较差异均无统计学意义(P>0.05);多因素Logistic回归分析结果显示,误吸史、老年痴呆、帕金森氏病、脑卒中、自主进食情况以及义齿情况均是脑梗死合并吸入性肺炎的危险因素(P<0.05);观察组患者死亡17例(53.13%),明显高于对照组患者死亡2例(7.14%),差异有显著统计学意义(P<0.01)。结论误吸史、老年痴呆、帕金森氏病、脑卒中、是否自主进食以及饮酒是脑梗死合并吸入性肺炎的危险因素,对于控制不理想的有基础疾病与反复发生呛咳的患者,可以给予胃管鼻饲处理以防止吸入性肺炎的发生。
Objective To study the risk factors of cerebral infarction complicated with aspiration pneumonia and its nursing countermeasures. Methods Sixty patients with acute cerebral infarction treated in Baoji People's Hospital from April 2015 to January 2018 were selected as the study subjects. Thirty-two patients confirmed as aspiration pneumonia were taken as the observation group, and twenty-eight patients without definite diagnosis or without cerebrovascular disease were taken as the control group. All patients were given optimized cluster nursing. The risk factors of inhalation pneumonia in patients with cerebral infarction were analyzed. Results Compared with the control group, inhalation history(78.12% vs 35.71%), Alzheimer's disease(56.25% vs 17.84%), Parkinson's disease(81.25% vs 7.14%),stroke(75.00% vs 46.43%), whether to eat independently(84.38% vs 10.71%) and alcoholic patients(65.63% vs 28.60%)of the observation group was significantly higher(all P<0.05). There were no significant difference in the number of diabetes, hypertension, hypoalbuminemia, smoking and elevated urinary creatinine levels between the two groups(all P>0.05). Multivariate logistic regression analysis showed that inhalation history, Alzheimer's disease, Parkinson's disease,stroke, self-feeding and denture were all risk factors for cerebral infarction complicated with aspiration pneumonia(P<0.05). There were 17 death cases(53.13%) in the observation group, which was significantly higher than 2 death cases(7.14%) in the control group(P<0.01). Conclusion Inhalation history, Alzheimer's disease, Parkinson's disease, stroke,whether to eat independently and drink alcohol are risk factors for inhalation pneumonia in patients with cerebral infarction. For the patients with underlying diseases and recurrent cough, the treatment of gastric tube nasal feeding can effectively prevent the occurrence of inhalation pneumonia.
Objective To study the risk factors of cerebral infarction complicated with aspiration pneumonia and its nursing countermeasures. Methods Sixty patients with acute cerebral infarction treated in Baoji People's Hospital from April 2015 to January 2018 were selected as the study subjects. Thirty-two patients confirmed as aspiration pneumonia were taken as the observation group, and twenty-eight patients without definite diagnosis or without cerebrovascular disease were taken as the control group. All patients were given optimized cluster nursing. The risk factors of inhalation pneumonia in patients with cerebral infarction were analyzed. Results Compared with the control group, inhalation history(78.12% vs 35.71%), Alzheimer's disease(56.25% vs 17.84%), Parkinson's disease(81.25% vs 7.14%),stroke(75.00% vs 46.43%), whether to eat independently(84.38% vs 10.71%) and alcoholic patients(65.63% vs 28.60%)of the observation group was significantly higher(all P<0.05). There were no significant difference in the number of diabetes, hypertension, hypoalbuminemia, smoking and elevated urinary creatinine levels between the two groups(all P>0.05). Multivariate logistic regression analysis showed that inhalation history, Alzheimer's disease, Parkinson's disease,stroke, self-feeding and denture were all risk factors for cerebral infarction complicated with aspiration pneumonia(P<0.05). There were 17 death cases(53.13%) in the observation group, which was significantly higher than 2 death cases(7.14%) in the control group(P<0.01). Conclusion Inhalation history, Alzheimer's disease, Parkinson's disease, stroke,whether to eat independently and drink alcohol are risk factors for inhalation pneumonia in patients with cerebral infarction. For the patients with underlying diseases and recurrent cough, the treatment of gastric tube nasal feeding can effectively prevent the occurrence of inhalation pneumonia.
引文
[1]王楠,张立新.延髓梗死后吞咽障碍的研究进展[J].中国康复理论与实践, 2018, 24(7):807-811.
[2]张瑜,贺利峰,汤永国,等.急性脑梗死老年患者肺部感染的病原学特征及影响因素分析[J].中华医院感染学杂志, 2018, 28(13):1947-1950.
[3]耿爱香,赵琨.卒中相关性肺炎的预测和预防方法护理研究进展[J].中华护理杂志, 2017, 52(S1):85-89.
[4]周凯,刘济滔,胡沥,等.老年急性脑梗死患者呼吸机相关性肺炎及影响因素分析[J].中国现代医学杂志, 2017, 27(13):114-116.
[5]张英,魏萍,刘宗美,等.住院内科患者吸入性肺部感染的管理流程建构研究[J].中华医院感染学杂志, 2017, 27(6):1413-1416.
[6]杨丽,蒋玉华,张雪,等.老年患者吸入性肺炎相关因素分析与预防研究[J].中华医院感染学杂志, 2016, 26(13):2948-2950.
[7]张瑜,程曼,姚源蓉.复发性脑梗死患者发生早期神经功能恶化的相关危险因素分析[J].实用医学杂志, 2016, 32(7):1037-1040.
[8]劳嘉良,张凝远,吴小练,等.重症脑梗死患者呼吸机相关性肺炎的特征与危险因素分析[J].中华医院感染学杂志, 2015, 25(17):3967-3969.
[9]邹小芳,于书慧,刘青,等.不同吞咽功能评估方法及康复策略在老年吞咽障碍患者中的应用[J].广东医学, 2015, 36(10):1624-1626.
[10]吴俊,张玲.呼吸科病房卒中相关性肺炎病原体的分布及耐药性分析[J].中国感染与化疗杂志, 2015, 15(3):217-221.
[11]解晓帅,朱立勤.老年吸入性肺炎治疗的药学监护[J].中国临床药理学杂志, 2015, 3(9):756-757, 761.
[12]周文军.老年重症脑梗死发生肺部感染的相关因素及中医治疗[J].中华中医药学刊, 2015, 33(5):1180-1182.
[13]王会,马文平,冯凯.急性脑梗死患者卒中相关性肺炎的危险因素[J].临床神经病学杂志, 2014, 27(4):300-302.
[14]童丽灵,王曙红,王伟,等.鼻饲管置入深度及鼻饲时患者体位与食物反流及并发症的关系[J].世界华人消化杂志, 2014, 22(18):2588-2592.
[15]王晓华,高燕飞,王秋燕,等.老年患者发生吸入性肺炎的相关因素分析与对策[J].中华医院感染学杂志, 2014, 24(5):1161-1162,1165.
[16]王凌云,吴莉莉,何秀娃.长期卧床患者预防吸入性肺炎的护理[J].中华医院感染学杂志, 2014, 23(21):5164-5165.
[17]卢彩霞,陈淑萍,胡敏芳.老年脑卒中患者吸入性肺炎危险因素分析及康复护理[J].中华医院感染学杂志, 2014, 23(17):4125-4126.
[2]张瑜,贺利峰,汤永国,等.急性脑梗死老年患者肺部感染的病原学特征及影响因素分析[J].中华医院感染学杂志, 2018, 28(13):1947-1950.
[3]耿爱香,赵琨.卒中相关性肺炎的预测和预防方法护理研究进展[J].中华护理杂志, 2017, 52(S1):85-89.
[4]周凯,刘济滔,胡沥,等.老年急性脑梗死患者呼吸机相关性肺炎及影响因素分析[J].中国现代医学杂志, 2017, 27(13):114-116.
[5]张英,魏萍,刘宗美,等.住院内科患者吸入性肺部感染的管理流程建构研究[J].中华医院感染学杂志, 2017, 27(6):1413-1416.
[6]杨丽,蒋玉华,张雪,等.老年患者吸入性肺炎相关因素分析与预防研究[J].中华医院感染学杂志, 2016, 26(13):2948-2950.
[7]张瑜,程曼,姚源蓉.复发性脑梗死患者发生早期神经功能恶化的相关危险因素分析[J].实用医学杂志, 2016, 32(7):1037-1040.
[8]劳嘉良,张凝远,吴小练,等.重症脑梗死患者呼吸机相关性肺炎的特征与危险因素分析[J].中华医院感染学杂志, 2015, 25(17):3967-3969.
[9]邹小芳,于书慧,刘青,等.不同吞咽功能评估方法及康复策略在老年吞咽障碍患者中的应用[J].广东医学, 2015, 36(10):1624-1626.
[10]吴俊,张玲.呼吸科病房卒中相关性肺炎病原体的分布及耐药性分析[J].中国感染与化疗杂志, 2015, 15(3):217-221.
[11]解晓帅,朱立勤.老年吸入性肺炎治疗的药学监护[J].中国临床药理学杂志, 2015, 3(9):756-757, 761.
[12]周文军.老年重症脑梗死发生肺部感染的相关因素及中医治疗[J].中华中医药学刊, 2015, 33(5):1180-1182.
[13]王会,马文平,冯凯.急性脑梗死患者卒中相关性肺炎的危险因素[J].临床神经病学杂志, 2014, 27(4):300-302.
[14]童丽灵,王曙红,王伟,等.鼻饲管置入深度及鼻饲时患者体位与食物反流及并发症的关系[J].世界华人消化杂志, 2014, 22(18):2588-2592.
[15]王晓华,高燕飞,王秋燕,等.老年患者发生吸入性肺炎的相关因素分析与对策[J].中华医院感染学杂志, 2014, 24(5):1161-1162,1165.
[16]王凌云,吴莉莉,何秀娃.长期卧床患者预防吸入性肺炎的护理[J].中华医院感染学杂志, 2014, 23(21):5164-5165.
[17]卢彩霞,陈淑萍,胡敏芳.老年脑卒中患者吸入性肺炎危险因素分析及康复护理[J].中华医院感染学杂志, 2014, 23(17):4125-4126.