脑卒中与急性肺损伤的临床研究

A clinical study on stroke and acute lung injury

目的 了解脑卒中并发急性肺损伤 (ALI)的发生、发展过程 ,并对其危险因素进行探讨。方法 1999年 2～ 9月收治的急性脑卒中患者 6 4例 ,随机分为脑卒中并发ALI组 31例 ,男 2 3例 ,女 8例 ,平均年龄 (6 7± 8)岁 ;脑卒中未并发ALI组 33例 ,男 2 1例 ,女 12例 ,平均年龄 (6 2± 10 )岁。对两组的年龄、性别、脑卒中类型以及急性期脑功能指标和肺功能指标进行分析比较。结果 高龄、意识障碍、哥拉斯格 匹斯堡昏迷评分 (GCS P)降低、咳嗽反射减弱、吞咽困难、鼻胃管饲、下呼吸道感染和发热等是ALI的重要危险因素 ;性别、脑卒中类型、病前呼吸道疾病史和有无呕吐无统计学意义。ALI组入院第 1天 (脑卒中发病第 1～ 3天 ) ,ALI的发生率为 19% ,入院第 3天增至 81% ,第 5天高达95 %。给氧治疗前 ,动脉血氧分压是判断ALI的重要指标 ;给氧治疗后 ,用氧合指数 (PaO2 /FiO2 )反映ALI状况更为准确合理。结论 脑卒中急性期脑功能损伤严重或并发下呼吸道感染者 ,ALI发生率明显增高 ,尤其是老年人。

Objective To understand the course of occurrence and development of stroke complicated with acute lung injury (ALI) and to explore the risk factors of acute lung injury.Methods Sixty four patients with stroke admitted from February to September,1999,were randomly divided into two groups,31 cases (23 males and 8 females) with mean age of 67±8 years in ALI group (Group 1),and 33 cases (21 males and 12 females) with mean age of 62±10 years in the group without acute lung injury (Group 2).Age,sex,stroke types,brain functions,and lung functions in these two groups were studied.Results It was found that advanced age,unconsciousness,Glasgow Pittsburgh coma score (GCS P) reduction,cough and swallowing reflex reduction,lower respiratory tract infection and fever were risk factors of acute lung injury.Sex,stroke types,respiratory disease history and vomiting had no statistical significance.The incidence of acute lung injury in Group 1 was 19% on the first day in hospital ( 2～3 days after stroke),80.6% on the third day and 95.2% on the fifth day.Before oxygen treatment,PaO 2 was an important index for judging acute lung injury.After that,PaO 2/FiO 2 was more reasonable for judging than PaO 2.Conclusion Severe brain function injury and lower respiratory tract infection in acute phase of stroke may increase incidence of acute lung injury,especially in the elderly.