老年脑卒中患者相关性肺炎的危险因素分析

Analysis of risk factors for pneumonia associated to elderly patients with cerebral stroke

目的分析老年脑卒中患者发生相关性肺炎的危险因素，为预防相关性肺炎的发生提供依据。方法选取2010年2月至2012年2月我院神经内科收治的248例老年脑卒中患者病例资料，分析患者脑卒中情况、基础疾病、治疗情况及预后情况，并采用单因素分析及多因素Logistic回归分析老年脑卒中患者相关性肺炎发生的相关因素。结果248例老年脑卒中患者发生相关性肺炎者78例（31．5％），其中以人院48h后发病者居多，为48例，48h以内发病者30例（38．5％）。78例相关性肺炎患者菌群分析结果显示金黄色葡萄球菌34例、大肠埃希菌22例、鲍曼不动杆菌15例、肺炎球菌11例、铜绿假单胞菌7例、奈瑟氏菌2例。单因素分析显示老年人年龄、意识状况、基础疾病情况、神经功能缺损评分（NIHSS）、卒中部位、鼻饲治疗等均与相关性肺炎发生相关，且与未合并相关性肺炎者相比，老年脑卒中合并相关性肺炎患者年龄偏大，存在延髓性麻痹及意识障碍比例偏高，既往有基础疾病患者比例明显增高，人院时NIHSS评分增高者及脑干卒中、鼻饲治疗者比例偏高。多因素Logistic回归分析显示年龄≥65岁、肺部疾病史、延髓性麻痹、意识障碍、鼻饲治疗是老年人脑卒中相关性肺炎发生的危险因素。老年脑卒中合并相关性肺炎患者较非合并相关性肺炎者住院时间明显延长，分别为（31．3＋20．4）d与（17．6±8．1）d（t=7．57，P=0．001）；合并相关性肺炎患者病死率为41．0％，明显高于未合并相关性肺炎者4．1％（t=54．96，P=0.000）。多因素Logistic回归分析结果显示，影响死亡的独立因素为年龄≥75岁（OR=1．6，95％CI：1．0～2．6）、NIHSS〉13分（0R=5．0，95％CI：1．7～24．6）及肺部感染（OR：5．2，95％CI：1．8～17．3）。结论老年脑卒中患者相关性肺炎的发生与患者年龄、基础疾病、意识状态及NIHSS评分情况有关，对其相关因素进行预防及治疗可有效改善预后。

Objective To investigate the risk factors with cerebral stroke. Methods Totally 248 elderly of pneumonia associated to elderly patients patients with stroke were retrospectively analyzed on medical history, treatment and prognosis. Results In 248 cases of senile stroke patients, 78 cases had an associated pneumonia, accounting for 31.5%. The onset with admission period 48 h was in majority （48 cases）, less than 48 h in 30 cases （38.5%）. 12 patients （15.4%） were involved blood culture, 38 cases sputum culture, accounting for 48.70/oo. In the univariate correlation analysis, older age, consciousness, basic diseases, stroke location, NIHSS score of nasal feeding therapy were associated with associated pneumonia （all P^0.05）. As compared to patients without no associated pneumonia, the patients with associated pneumonia had more aged and higher proportions of bulbar paralysis and impaired consciousness, more underlying diseases. At the time of admission, increased occurrences of National Institute of Health Stroke Scale （NIHSS） score, brainstem stroke and multiple feeding treatment appeared in most of patients. Multivariate Logtistic regression analysis showed that age 65 years, history of pulmonary disease, bulbar paralysis,disturbance of consciousness, nasal treatment among older stroke were the associated pneumonia risk factors. The hospitalized time was prolonged （（31.3 ± 20. 4） d and （17.6 ± 8. 1） d, t = 7.57, P = 0. 0011 and fatality rate increased （41.0% vs. 4.1%） in patients with pneumonia than without pneumonia（z2= 54.96,P=0. 000）. The independent factors of death were aged ≥ 75 years（OR= 1.6,95% CI ： 1.0-2.6 ）, NIHSS〉 13 （OR =5. 0, 95 % CI ： 1.7-24.6） and pulmonary infection （OR = 5.2,95% CI： 1.8-17.3）. Conclnsions The occurrence of associated pneumonia in elderly patients with cerebral stroke is related with age, underlying disease, state of consciousness and NIHSS scores. The prevention and treatment of relevant factors can improve prognosis.