急性脑卒中后医院内获得性肺炎的临床分析

Clinical analysis of nosocomial pneumonia after acute stroke

目的:探讨急性脑卒中患者发生医院内获得性肺炎(HAP)的危险因素及对患者预后的影响。方法:回顾性分析2003年1月至2011年9月期间住院的急性脑卒中患者,其中在住院期间发生HAP的患者作为病例组,未发生HAP的患者作为对照组。对危险因素采取χ2检验及多因素Logistic回归分析。对病例组和对照组病死率进行χ2分析。结果:单因素分析显示危险因素包括高龄(年龄>73岁)、美国国立卫生院卒中量表(NIHSS)评分高(≥10分)、意识障碍、吞咽障碍、机械通气、慢性阻塞性肺疾病(COPD)、低清蛋白血症、既往卒中史、贫血、管饲、使用制酸剂、肾功能异常、电解质紊乱;多因素Logistic回归分析显示年龄、NIHSS评分高、COPD、低清蛋白血症是感染的独立危险因素。病例组与对照组病死率有统计学差异。结论:患者高龄及NIHSS评分高是急性脑卒中后HAP的主要危险因素。发生HAP的急性脑卒中患者病死率高。

Objective To explore the risk factors of nosocomial pneumonia and their impact on prognosis in patients with acute stroke. Methods A retrospective case-control study was performed on 241 cases of acute stroke hospitalized from January 2003 to September 2011. Patients complicated with nosocomial pneumonia （135 cases） were categorized as infection group and those without nosocomial pneumonia （106 cases） were categorized as control group. The risk factors were analyzed by univariate analysis and multivariate logistic regression analysis. The case fatality rate of infection group and control group was analyzed by χ2-test. Results Univariate analysis showed that elderly, the National Institutes of Health stroke scale （NIHSS） ≥ 10, disturbance of consciousness, dysphagia, mechanical ventilation, chronic obstructive pulmonary disease （COPD）, hypoalbuminemia, history of stroke, anemia, tube feeding, anti-acid drugs, abnormal renal function and electrolyte imbalance were the risk factors. Multivariate logistic regression showed that elderly, NIHSS ≥ 10, COPD and hypoalbuminemia were the independent risk factors. The case fatality rate of infection group was higher than that of control group. Conclusions Elderly and NIHSS ≥10 are the major risk factors of nosocomial pneumonia after acute stroke. The case fatality rate of infection group is higher than that of control group.