神经科重症监护室感染的控制-王宁.ppt
《神经科重症监护室感染的控制-王宁.ppt》由会员分享,可在线阅读,更多相关《神经科重症监护室感染的控制-王宁.ppt(53页珍藏版)》请在三一文库上搜索。
1、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 NICU呼吸道感染的诊断 NICU呼吸道感染的治疗,重症监护室是神经科重要组成部分,神经科重症监护室(neurological intensive care unit,NICU) 脑出血是神经科的急症、重症,具有较高的死亡率和致残率 据估计约8 一10的急性卒中患者需要重症监护,B. Indredavik, F. Bakke,; S.A. Slrdahl, et al.Stroke,1998
2、,29(5):895899,NICU治疗显著提高长期生活质量,卒中5年后Nottingham健康量表(NHP)评分,一项随机、对照研究,220例患者分为NICU组及普通病房组,NHP评分,B. Indredavik, F. Bakke,; S.A. Slrdahl, et al.Stroke,1998,29(5):895899,NICU治疗显著提高长期生活质量,TABLE 1. The Mean/Median Scores and Proportion of Patients With a Score of 30 on FAI for Stroke Unit and General Wards
3、 Patients Assessed 5 Years After Stroke,*Percentages were calculated from patients alive after 5 years: in the stroke unit (SU) group, 45 patients; in the general wards (GW) group, 32 patients.,B. Indredavik, F. Bakke,; S.A. Slrdahl, et al.Stroke,1998,29(5):895899,NICU感染形势严峻,脑卒中患者感染发生率,Bruce Ovbiage
4、le,MD,et al. Journal of Stroke and Cerebrovascular Diseases, 2006;5(15):209-213,11家医院,663例缺血性脑卒中患者,住院期感染发生率,感染率%,11家医院间感染率不同,变化范围为肺炎:0-27%;泌尿系感染:5-22%,脑卒中相关性肺炎,脑卒中相关性肺炎(stroke associated pneumonia,SAP)是急性脑卒中后常见并发症,脑卒中患者有7-22% 的因并发肺炎而使得病程变得复杂,Langhorne P,et al. Stroke 2000; 31:1223-9.,SAP在NICU的发生率,1.
5、Ruediger Hilker.MD,et al. Stroke,2003;34:975-981 2. Uwe Walter,et al. J Neurol (2007) 254:13231329,124例NICU急性脑卒中患者,检测有病原的SAP发生率为 ,与既往已发表的文献中的普通ICU发生率相当1,236例NICU急性缺血性脑卒中患者SAP的发生率为,21%,21.6%2,The types and rates of ICU acquired infections per 100 patients admitted and per 1000 patient days,UTI: Urina
6、ry tract infection; PBSI: primary bloodstream infection; STI: soft tissue infection,J. Infect.Dis. 2007;60:8791,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 Hilker.MD,et al. Stroke,2003;34:975-981,SAP的临床危险因素,R Dziewas,et al. J Neurol Neurosurg Psychiatry 2004;75:852856.,NICU感
7、染发生率较普通病房更高,钱树星,龙军,等.中华神经医学杂志, 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.,ResultsInfections, either total or specific, were not found more frequently in cases than controls. However, patients
8、with a recent respiratory tract infection suffered more often from large-vessel atherothromboembolic or cardioembolic stroke than did patients without infection (48% vs 24%, P0.07). ConclusionsOur results suggest that respiratory tract infection may act as a trigger and increase the risk of large-ve
9、ssel 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: 4953,脑卒中感染患者第7天时亚组Kaplan-Meier生存曲线,SAP显著增加住院期间患者病死率,死亡率%,P0.05,RR:3.3,Ruediger H
10、ilker.MD,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,P0.05,RR:2.5 95%CI:1.0-5.9,死亡率%,Ruediger Hilker.MD,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,翟云霞.中国老年学杂志2003,23:466,P0.01,P0.01,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,等.中华神经医学杂志,
- 配套讲稿:
如PPT文件的首页显示word图标,表示该PPT已包含配套word讲稿。双击word图标可打开word文档。
- 特殊限制:
部分文档作品中含有的国旗、国徽等图片,仅作为作品整体效果示例展示,禁止商用。设计者仅对作品中独创性部分享有著作权。
- 关 键 词:
- 神经科 重症 监护 感染 控制 王宁
链接地址:https://www.31doc.com/p-2733245.html