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目的 探讨高分级动脉瘤性蛛网膜下腔出血患者术后肺炎病原学特点和其耐药性，为抗菌药物的合理使用提供参考依据。 方法 回顾性分析2013年10月—2020年12月手术治疗的Hunt-Hess Ⅳ～Ⅴ级动脉瘤性蛛网膜下腔出血患者的临床资料，分析痰培养病原菌情况及抗菌药物敏感试验结果。 结果 共纳入183例患者，均有肺部感染，其中122例（66.7%）行气管切开治疗。有451份痰培养标本，其中284份（63.0%）痰培养标本为阳性，检出病原菌305株，其中革兰阴性菌229株（75.1%）、革兰阳性菌38株（12.5%）、真菌38株（12.5%），未发现厌氧菌，混合感染有21份（7.4%）。183例肺部感染患者中痰培养病原菌改变者44例（24.0%）。革兰阴性菌主要是肺炎克雷伯杆菌（32.8%）、鲍曼不动杆菌（16.2%）、铜绿假单胞菌（14.4%）和大肠杆菌（12.7%），其中肺炎克雷伯杆菌和鲍曼不动杆菌产超广谱β-内酰胺酶菌株的比例分别为36.0%、51.4%；药敏试验结果显示其对亚胺培南、哌拉西林/他唑巴坦、妥布霉素、替加环素敏感性高。革兰阳性菌主要是金黄色葡萄球菌属（92.1%），其中耐甲氧西林金黄色葡萄球菌的比例为48.6%；药敏试验结果显示其对万古霉素、利奈唑胺和利福平敏感性高。真菌主要是白色念珠菌（39.5%），对抗真菌药物均敏感。 结论 高分级动脉瘤性蛛网膜下腔出血患者术后肺部感染率高，以革兰阴性菌为主，耐药性强，应根据其病原学特点和药敏试验结果合理选用抗菌药物。 Abstract: Objective To investigate the etiology characteristics and drug resistance of post-microsurgery pneumonia in patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH), to provide reference for rational use of antibiotics. Methods The clinical data of patients with Hunt-Hess Ⅳ-Ⅴ aSAH who received microsurgery treatment were retrospectively analyzed, to analyze the sputum culture pathogens and antimicrobial susceptibility test (AST). Results A total of 183 cases were included in this study, and they all had lung infection and 122 cases (66.7%) received tracheotomy. Of 451 sputum specimens, 284 (63.0%) were positive. 305 strains of bacteria were isolated from positive specimens, including 229 strains (75.1%) of Gramnegative bacteria, 38 strains (12.5%) of Gram-positive bacteria, 38 strains (12.5%) of fungi, and no anaerobic bacterium was found. The mixed infection occurred in 21 specimens (7.4%). Sputum culture bacteria changed in 44 cases (24.0%). The Gram-negative bacteria were mainly Klebsiella pneumoniae (32.8%), Acinetobacter baumannii (16.2%), pseudomonas aeruginosa (14.4%) and escherichia coli (12.7%). The ratio of Klebsiella pneumoniae and Acinetobacter banmannii producing the extended spectrum β-lactamases (ESBLs) strains was 36.0% and 51.4%, respectively; and the AST showed that most of the strains were sensitive to imipenem, piperacillin and tazobactam, tobramycin, and tegacyclin. The Gram-positive bacteria were mainly Staphylococcus aureus (92.1%), of which the proportion of Methicillin-resistant Staphylococcus aureus (MRSA) were 48.6%; and the AST showed that the strains were sensitive to vancomycin, linezolid and Li Fuping. Fungi was mainly Candida albicans (39.5%), and they were sensitive to antifungal drugs. Conclusions The patients with poor-grade aSAH had high risk of post-microsurgery pneumonia; and the pathogens were mainly Gram-negative bacteria, and they had strong drug resistance.

Objective To investigate the effect of mechanical vibration sputum expectoration in the adjuvant treatment of stroke-associated pneumonia. Methods Totally 60 patients with stroke-associated pneumonia were divided into control group (n=30)and study group(n=30) according to the arrival sequences of hospital admission. All patients received anti-infective therapy for stroke-associated pneumonia. The routine hand-assisted percussion on the back was adopted in the control group, while the mechanical vibration sputum expectoration was carried out in the study group. The clinical symptoms and clinical pulmonary infection scores of the two groups were observed at one week after intervention. Results The overall response rate of treatment was 96. 67%(29/30)in the study group, which was higher than 80. 00%(24/30)in the control group (P＜0. 05). Patients in the study group had a higher volume of sputum expectoration and shorter time to moist rale disappear compared with those in the control group (P＜0. 01). Patients in the study group achieved better outcomes of respiratory rate, SaO 2 and PaO 2 compared with those in the control group (P＜0. 01). Conclusion Application of mechanical vibration sputum expectoration is potentially effective to improve the condition of patients and enhance the treatment efficacy of stroke-associated pneumonia. (目的 探讨机械振动排痰辅助治疗卒中相关性肺炎的效果。方法 选取2019年 2 月—2020 年 8 月医院收治的脑卒中患者60例为研究对象, 均确诊卒中相关性肺炎。按患者入院时间顺序分为对照组和研究组, 各30例。2组患者均接受基础抗感染治疗, 对照组给予传统人工叩背手段排痰, 研究组给予机械振动排痰。1周后观察2组患者的临床症状和临床肺部感染评分。结果 研究组总有效率96. 67%(29/30), 高于对照组的80. 00%(24/30), 差异有统计学意义(P＜0. 05)。研究组排痰量多于对照组, 肺部湿啰音消失时间短于对照组, 差异有统计学意义(P＜0. 01)。研究组呼吸频率、血氧饱和度(SaO 2 )、动脉血氧分压(PaO 2 )改善幅度优于对照组, 差异有统计学意义(P＜0. 01)结论 运用机械振动排痰辅助治疗可以改善卒中相关性肺炎善患者肺部感染病情, 提高治疗效果。)

Objective To observe the effect of diet intervention with food thickener in prevention of stroke-associated pneumonia (SAP) and relief of dysphagia. Methods Totally 180 patients with dysphagia after stroke were randomly divided into the observation group and control group, with 90 cases in each group. All patients received routine care and rehabilitation training, and those in the observation group were given systematic diet intervention with food thickener. The incidences of SAP and aspiration were observed, and the recovery of swallowing function was evaluated by Water Swallow Test. Results The incidence of aspiration in the observation group was lower than that in the control group (P＜0. 05). The incidence of dysphagia in the observation group was lower than that in the control group (P＜0. 05). There was no significant difference in rate of swallowing function recovery between two groups (P＜0. 05). Conclusion The diet intervention with food thickener is effective to reduce the risk of aspiration, showing a positive role in prevention of SAP. (目的 观察食品增稠剂预防卒中相关性肺炎及改善吞咽困难的临床效果。方法 将180例脑卒中吞咽困难患者随机分为观察组和对照组, 各90例。对照组给予常规护理和康复训练, 观察组在常规护理的基础上行系统性食品增稠剂饮食训练。干预后观察并记录患者卒中相关性肺炎的发生情况, 根据洼田饮水试验对患者吞咽障碍恢复效果进行评价。结果 观察组患者误吸发生率低于对照组, 差异有统计学意义(P＜0. 05); 观察14 d后, 观察组卒中相关性肺炎发生率低于对照组, 差异有统计学意义(P＜0. 05)。两组吞咽功能好转率比较, 差异无统计学意义(P＞0. 05)。结论 通过食品增稠剂的应用可以明显减少呛咳、噎食的发生, 从而降低误吸的发生风险, 对卒中相关性肺炎起到积极的预防效果。)

Objective To observe the effect of diet intervention with food thickener in prevention of stroke-associated pneumonia (SAP) and relief of dysphagia. Methods Totally 180 patients with dysphagia after stroke were randomly divided into the observation group and control group, with 90 cases in each group. All patients received routine care and rehabilitation training, and those in the observation group were given systematic diet intervention with food thickener. The incidences of SAP and aspiration were observed, and the recovery of swallowing function was evaluated by Water Swallow Test. Results The incidence of aspiration in the observation group was lower than that in the control group (P＜0. 05). The incidence of dysphagia in the observation group was lower than that in the control group (P＜0. 05). There was no significant difference in rate of swallowing function recovery between two groups (P＜0. 05). Conclusion The diet intervention with food thickener is effective to reduce the risk of aspiration, showing a positive role in prevention of SAP. (目的 观察食品增稠剂预防卒中相关性肺炎及改善吞咽困难的临床效果。方法 将180例脑卒中吞咽困难患者随机分为观察组和对照组, 各90例。对照组给予常规护理和康复训练, 观察组在常规护理的基础上行系统性食品增稠剂饮食训练。干预后观察并记录患者卒中相关性肺炎的发生情况, 根据洼田饮水试验对患者吞咽障碍恢复效果进行评价。结果 观察组患者误吸发生率低于对照组, 差异有统计学意义(P＜0. 05); 观察14 d后, 观察组卒中相关性肺炎发生率低于对照组, 差异有统计学意义(P＜0. 05)。两组吞咽功能好转率比较, 差异无统计学意义(P＞0. 05)。结论 通过食品增稠剂的应用可以明显减少呛咳、噎食的发生, 从而降低误吸的发生风险, 对卒中相关性肺炎起到积极的预防效果。)