RESUMO
Objective:To investigate the pathogenic bacteria distribution and risk factors of pulmonary infection after tracheotomy in patients with stroke coma,and to put forward preventive measures.Methods:96 patients with stroke coma from January 2016 to February 2017 in our hospital were retrospectively analyzed.The incidence of pulmonary infection and distribution of pathogenic bacteria of patients with stroke coma were analyzed.At the same time,the risk factors of pulmonary infection were analyzed by single factor and multiple factors logistic regression analysis,and corresponding preventive measures were put forward.Results:The incidence of pulmonary infection after tracheotomy in 96 patients with stroke coma was 48.96％ (47/96).A total of 104 pathogens were isolated and cultured,including gram negative bacteria 69 strains (66.35％),gram positive bacteria 20 strains (19.23％) and fungus 15 strains (14.42％).Single factor regression analysis results showed that pulmonary infection after tracheotomy in patients with stroke coma was closely related with age,basic diseases,time of tracheotomy,and bed time,use of broad-spectrum antibiotics,smoking history,artificial airway,times of sputum suction and inhalation(P＜0.05),and it was not related to the patient's gender,weight,stroke type (P＞0.05).Multivariate logistic regression analysis showed that age 45 years old,complicated with basic disease,time oftracheotomy 5 d,use of broad-spectrum antibiotics,smoking history and the establishment of artificial airway were risk factors of pulmonary infection after tmcheotomy in patients with stroke coma (P＜0.05).ROC analysis results showed that the critical point (threshold C) oftmcheotomy time was 4.3 days,and the sensitivity and specificity were 0.851 and 0.918 respectively.Conclusion:The main pathogenic bacteria of pulmonary infection after tracheotomy in patients with stroke coma is gram-negative bacteria,age 45 years old,complicated with basic disease,time of tmcheotomy 5d,use of broad-spectrum antibiotics,smoking history and the establishment of artificial airway can lead to pulmonary infection after tracheotomy in patients with stroke coma,and the risk of pulmonary infection in patients with stroke coma will increase considerably after the time of tracheotomy for more than 4.3 days.Targeted measures should be taken to reduce the risk of pulmonary infection according to pathogenic features and risk factors.
RESUMO
OBJECTIVE:To observe the effect and safety of small-dose argatroban vs. aspirin in the treatment of acute cerebral infarction. METHODS:136 patients with acute cerebral infarction were randomly divided into observation group and control group. All patients were given routine treatment,such as anti-intracranial pressure,oxidative stress,brain protection,oxygen,blood pres-sure,blood sugar control,anti-infective,water and electrolyte acid-base balance,etc. Based on it,control group was treated with Arginine aspirin for injection 100 mg,adding into 0.9% Sodium chloride injection 250 ml,iv,once a day. Observation group was treated with Argatroban injection 40 mg,adding into 0.9% Sodium chloride injection 500 ml,24 h continuous infusion for continu-ous 2 d,iv;then dose was decreased to 10 mg,adding into 0.9% Sodium chloride injection 100 ml,iv,once a day,for continu-ous 5 d. The course of both was 7 d. The clinic data was observed,including clinical efficacy,NIHSS(National Institutes of Health Stroke Scale)score,Bathel index scores before and after treatment,and incidence of adverse reactions. The recurrence rate of cere-bral infraction during the 2-year follow-up period was observed. RESULTS:The total effective rate in observation group was signifi-cantly higher than control group,the recurrence rates of cerebral infarction in observation group within 1 and 2 year(s)were signifi-cantly lower than control group,with significant difference(P0.05). CONCLUSIONS:Based on the conventional treatment,compared with aspirin, small-dose argatroban can significantly commute the nerve function of acute cerebral infarction,and reduce the recurrence rate of cerebral infarction,with good safety.