急性脑卒中后感染对其近期预后的影响

Effects of post-stroke infection on short-term prognosis of patients with acute stroke

目的研究急性脑卒中后感染对其近期预后的影响。方法对2008年1月1日-2009年12月31日在上海交通大学附属第六人民医院金山分院神经内科住院治疗的急性脑卒中患者进行观察研究。比较感染组与非感染组患者入院时和入院后21d的神经功能缺损程度、残障程度、日常生活能力及营养状况,比较两组其他并发症发生率、病死率、住院时间及治疗费用。结果入院后21d,感染组的改良的Rankin量表(mRS)及Barthel指数(BI)评分改善程度均显著低于非感染组(P值均<0.01),美国国立卫生院卒中量表(NIHSS)评分改善程度虽有低于非感染组的趋势,但差异无统计学意义(P=0.509)。感染组入院后21d的营养不良发生率(51.7%)显著高于入院时(31.5%,P<0.01);而非感染组入院后21d的营养不良发生率(4.2%)与入院时(3.2%)的差异无统计学意义(P=0.388)。感染组的其他并发症发生率(67.3%)和病死率(11.9%)均显著高于非感染组(16.2%和2.3%,P值均<0.01)。感染组的住院天数显著长于非感染组(P<0.01),住院总费用及药物费用均显著高于非感染组(P值均<0.01)。结论急性脑卒中后感染是导致急性脑卒中病死率增加、近期临床预后不良、住院时间延长及医疗费用增加的重要因素。

Objective To investigate the effects of post-stroke infection on the prognosis of patients with acute stroke. Methods We prospectively investigated the acute stroke patients who were treated in our department between Jan. 2008 and Dec. 2009. Inclusion criteria： ① hospitalized patients with acute stroke within 2 weeks after onset; ② patients were diagnosed with acute stroke by CT or MRI. The selected patients were divided into infection group and non-infection group. The neurological deficit degrees, disability degrees, activity of daily living （ADL） and nutritional status between two groups were compared on admission and on the 21st day after admission. The incidences of complications, mortality, hospital stay, total costs of hospitalization were also compared between the two groups. Results On the 21st day after admission, the improvement of national institute of health stroke scale （NIHSS） in infection group was less than that the in non-infection group, but with no significant difference （P=0.509）; the improvements of modified rankin scale （mRS） and barthel index （BI） in the infection group were both significantly less than those in the non-infection group （both P0.01）. The incidence of malnutrition in the infection group at the 21st day after admission was significantly higher than that at admission （51.7% vs. 31.5%, P0.01）, while the incidence of malnutrition in the non-infection group at the 21st day after admission was not significantly higher than that at admission （4.2% vs. of 3.2%, P=0.388）. The incidences of other complications and mortality in the infection group were significantly higher than those in the non-infection group （67.3% vs. 16.2%, P0.01; 11.9% vs. 2.3%, P0.01, respectively）. Patients in the non-infection group had shorter hospital stay, less hospitalization costs and drug costs than those in the infection group （all P0.01）. Conclusion Post-stroke infection is an important factor that lead to increased mortality rate, poor short-term outcome, longer hospital stay, and more costs in patients with acute stroke.