文档介绍：神经科重症监护室感染的控制
首都医科大学宣武医院神经外科
王 宁
主要内容
NICU在神经科的地位
NICU感染的面临的严峻形势
NICU呼吸道感染的危险因素
感染严重影响神经科患者预后
NICU的病原学
NICeam infection; STI: soft tissue infection
J. . 2007；60：87~91
NICU呼吸道感染的危险因素
NICU患者发生SAP的危险因素
显著增加脑卒中相关性肺炎（SAP）发生RR值的危险因素
Ruediger ,et al. Stroke,2003;34:975-981
*P＜, **P ＜ .
相对危险度（RR）
机械通气**
吞咽困难**
正常胸片**
脊椎基底
动脉卒中*
大脑多部
位卒中*
脊椎基底动脉多部位卒中**
SAP的临床危险因素
OR
P值
意识
(～)
＜
面瘫
(～)
＜
轻度偏瘫
(～)
失语
(～)
发音困难
(～)
疏忽
(～)
R Dziewas,et al. J Neurol Neurosurg Psychiatry 2004;75:852–856.
NICU感染发生率较普通病房更高
钱树星,龙军,, 2006,10(5):1050-1052
总的感染发生率%
Infection and Risk of Ischemic Stroke Differences Among Stroke Subtypes
A. Paganini-Hill, E. Lozano, G. Fischberg，et al.
Results—Infections, either total or specific, were not found more frequently in cases than controls. However, patients with a recent respiratory tract infection suffered more often from large-vessel atherothromboembolic or cardioembolic stroke than did patients without infection (48% vs 24%, ).
Conclusions—Our results suggest that respiratory tract infection may act as a trigger and increase the risk of large-vessel and/or cardioembolic ischemic stroke, especially in those without vascular risk factors.
Stroke. 2003;34:452-457
感染对NICU患者预后的影响
感染严重影响脑卒中患者预后
S. Aslanyana, C. J. Weir,et al. European Journal of Neurology, 2004, 11: 49–53
脑卒中感染患者第7天时亚组Kaplan-Meier生存曲线
吸入性肺炎
泌尿系感染
吸入性肺炎
泌尿系感染
无感染
SAP显著增加住院期间患者病死率
死亡率%
P＜，RR:
Ruediger ,et al. Stroke,2003;34:975-981
124例NICU急性脑卒中患者住院期间死亡率
SAP显著增加随访期间患者死亡率
P＜，RR:
95%CI:-
死亡率%
Ruediger ,et al. Stroke,2003;34:975-981
124例NICU急性脑卒中患者随访期间死亡率
合并院内感染的脑出血、脑梗死患者病死率
余 霞,,23:466
P＜
P＜
死亡率%
NICU呼吸道感染的常见病原体
珠江医院NICU呼吸道分离常见致病菌
钱树星,龙军,, 2006,10(5):1050-1052
2004年9月