卒中相关性肺炎危险因素研究

Analysis of the risk factors of stroke-associated pneumonia

目的探讨卒中相关性肺炎(SAP)的危险因素。方法对我院2005年1月1日～2007年1月1日神经内科ICU病房住院的595例脑卒中患者进行回顾性分析。结果(1)发生SAP者为310例(占52.10%),其中早发性肺炎患者225例(占37.82%),晚发性肺炎患者85例(占14.29%)。(2)单因素分析时年龄、心脏基础病、糖尿病、卒中部位、卒中性质、意识状态、鼻饲治疗、脱水剂、胃粘膜保护剂及预防性使用抗生素各组间比较P<0.05。(3)多因素分析时患者年龄每增加1岁,SAP发病率可增加1.037倍;糖尿病患者SAP发生率是非糖尿病患者的1.724倍;意识障碍评分每增加1分,SAP发生率下降0.908倍;有鼻饲治疗的卒中患者发生肺炎的可能性是没有鼻饲治疗患者的6.640倍;用胃粘膜保护剂的患者发生SAP的风险是没用患者的3.581倍;预防性使用抗生素的患者发生SAP的几率是未使用者的2.433倍。结论患者年龄、糖尿病史、意识状态、鼻饲治疗、胃粘膜保护剂及预防性使用抗生素是卒中相关性肺炎的危险因素。

Objective To explore the risk factors of stroke-associated pneumonia（SAP）. Methods A retrospective analysis was carried out to investigate the stroke patients admitted to the neurological intensive care unit at our hospital during January 1 st, 2005 to December 31 st, 2006. Results SAP occurred in 310 （ 52.1% ） of 595 patients, early-onset pneumonia developed in 225 of SAP. The total number of hospital stay more than 3 weeks was 113（50.3% ）in early-onset pneumonia patients, the incidence of 1 week onset was 70.6% in late-onset pneumonia patients. In single factor analysis there was statistical difference between the two groups divided by age, history of heart disease, diabetes, apoplexy position, category of cerebral stoke, conscious state, tube feeding, dehydrant, gastric mucosal protective drugs and antibiotic prophylax- is. Multiple factor analysis indicated that the incidence of SAP increased in the older patients, diabetes patients,lower GCS store patients,tube feeding patients, gastric mucosal protective drugs patients and antibiotic prophylaxis patients. Conclu- sion SAP is closely related to the following risk factors：age,diabetes,conscious state,tube feeding,gastric mucosal protective drugs and antibiotic prophylaxis.