重症监护老年脑卒中与肺炎的关系

Pneumonia in the elderly critically ill patients with stroke

目的确定老年重症监护脑卒中患者早期肺炎和院内获得性肺炎(NP)的发生情况和危险因素。方法回顾性调查125例老年重症监护脑卒中患者,对肺炎的多种危险因素进行多变量分析。结果125例患者中,肺炎65例(52%),脑干卒中和格拉斯哥昏迷评分低者(GCS＜9)可以预测早期肺炎的发生,NP与吞咽障碍、气管插管、GCS＜9、神经功能缺损评分高者(NIHSS评分≥13)密切相关,伴有NP者住院时间明显延长。死亡33例(26．4%),肺炎可增加死亡的危险。结论肺炎是老年重症监护脑卒中患者的常见并发症,与多种因素有关,并影响住院时间和预后,需要采取进一步的措施预防肺炎的发生。

Objective To estimate the incidence of early pneumonia and nosocomial pneumonia（NP）in the old critically ill patients with stroke,to determine risk factors for this complication,and to examine whether the occurrence of pneumonia is related to outcome. Methods We reviewed the medical records of the elderly critically ill patients with acute stroke. Incidence rates and risk factors of pneumonia and clinical outcome were determined. Results 125 patients were enrolled in the study. Pneumonia was observed in 65 （52%） patients. Using multivariate analysis,the independent predictors of early pneumonia was brainstem （OR2.3;95%CI 1.5～8.3） and a Glasgow coma score （GCS） less than 9 （OR3.1 ;95%CI 1.2～4.7）. The independent predictors of nosoeomial pneumonia were National Institutes of Health Stroke Scale （NIHSS） more than 13 （OR3.2;95% CI 1.1～4.6）,failure of swallowing evaluation （OR5.2;95%CI 1.3～12.7）,ever intubated （OR13;95%CI 6.8～19.7） and GCS less than 9 （OR4.2;95 %CI 2.7～ 14.5）. Also,nosocomial pneumonia was associated with prolonged hospitality. The presence of pneumonia increased mortality （OR4.6;95%CI 1.8～15.6）. Conclusion Severe disability,poor GCS,failure of swallowing evaluation and ever intubated independently predict the development of nosoeomial pneumonia. Aggressive preventive measures are needed to reduce pneumonia occurrence in the elderly stroke patients.