脑卒中获得性院内肺炎危险因素分析

Retrospective analysis on clinical feature and risk factors of hospital-acquired pneumonia in acute brain stroke

目的 回顾分析脑卒中合并获得性肺炎患者的临床资料和危险因素 ,提高对脑卒中获得性肺炎的认识。方法 收集 1999年 1月～ 2 0 0 1年 12月收住我院神经内科的脑卒中患者 ,按诊断标准分发生和未发生获得性肺炎组 ,对两组患者的临床特点、基础疾病、相关危险因素、病原菌和预后进行比较分析。结果 共收集脑卒中合并获得性肺炎 118例 ,同期未发生获得性肺炎的脑卒中患者 10 2例 ,L ogistic多因素分析提示发生获得性肺炎 OR的大小依次是慢性阻塞性肺病 (COPD)、意识障碍、年龄 >6 0岁、卧床超过 1周、吸烟、住院前存在肺炎、吞咽障碍和心衰 ,主要病原菌为以杆菌为主的条件致病菌 ,合并和非合并获得性肺炎的脑卒中患者死亡率分别为 2 6 .3%和9.2 %。结论 脑卒中合并获得性肺炎主要与高龄、吸烟、COPD和患者的脑卒中病情及心肺功能状态有关 ,发生获得性肺炎可增加患者的死亡率 。

Objective To obtain a farther understanding of the risk factors and stratagy of prevention and treatment of hospital-acquired pneumonia (HAP) in patients with acute brain stroke. Methods 118 patients with HAP and 102 cases without HAP were selected and served as a case-control study. The comparative analysis was performed in primary respiratory-related disorders and stroke symptoms,risk factors and prognosis by univariate and multivariate Logistic analysis between two groups. Results The risk factors emergenced significantly were chronic obstructive pulmonary disease(COPD),age over 60,confusion,long-time sickbed,pre-existed pneumonia and chronic heart failure. The mortality was 26.3%,significantly higher than non-HAP stroke. Conclusion Aged patients with stroke with COPD,severe brain symptoms or heart failure are susceptive to HAP. The presence of HAP can significantly increase the mortality of patients.