老年脑卒中患者相关性肺炎危险因素及临床特点分析

Risk factors and clinical characteristics of stroke-associated pneumonia in elderly patients

目的探讨老年重症脑卒中患者脑卒中相关性肺炎的发生率及危险因素。方法回顾性分析2008年1月～2010年12月入住北京安贞医院神经内科重症监护病房、年龄≥60岁急性脑卒中患者148例,分为肺炎组90例,无肺炎组58例,分析脑卒中相关性肺炎的发生率、危险因素及病原学情况。结果脑卒中相关性肺炎发生率为60.8%。logistic回归分析显示,年龄≥80岁、吸烟、长期卧床、美国国立卫生研究院卒中量表评分≥13分、格拉斯哥昏迷评分≤10分、吞咽障碍、机械通气、大脑中动脉主干梗死是脑卒中相关性肺炎的危险因素。肺炎组死亡33例(36.7%),无肺炎组死亡4例(6.9%),肺炎组病死率明显高于无肺炎组(P<0.01)。结论脑卒中相关性肺炎是脑卒中患者最严重的并发症之一,老年重症脑卒中患者更易发生肺部感染,直接导致病死率增加,临床医师应高度重视老年脑卒中患者肺炎的预防。

Objective To analyze the incidence, risk factors of stroke-associated pneumonia （SAP） in elderly inpatients of the neurological intensive care unit. Methods We retrospectively investigated 148 elderly acute stroke in patients（age≥60） of the neurological intensive care unit in Beijing Anzhen Hospital between January 2008 to December 2010. The patients were divided into SAP group（90 cases） and non-SAP group（58 cases）. The incidence,risk factors and etiology of the stroke associated pneumonia were discussed. Results The SAP incidence of elderly inpatients of neurological intensive care unit was 60.8%. Logistic regression analysis showed that senility, smoking, prolonged bed rest, critical neurological impairment, impaired consciousness, dysphagia, mechanical ventilation and stem infarction of middle cerebral artery were the risk factors for SAP. The mortality in the SAP group（33 of 90,36.7%） was much higher than the non-SAP group（4 of 58,6.9%,P〈0.01）. Conclusions SAP was one of the most critical complications after stroke. Elderly critical patients were more susceptible to SAP that resulted in high mortality. The clinicians should pay high attention to SAP.