脑卒中相关性肺炎的危险因素

Risk factors for stroke-associated pneumonia

目的探讨急性脑卒中患者卒中相关性肺炎(SAP)的发生率、危险因素及病原学特点。方法回顾性分析642例急性脑卒中患者病历资料,并分为SAP组和非SAP组,用单因素分析和多因素logistic回归分析SAP的相关危险因素,统计SAP患者的病原菌分布特点。结果 642例急性脑卒中患者SAP的发生率为13.2%,其中71.8%为早发性肺炎;脑梗死、脑出血、蛛网膜下腔出血患者SAP发生率分别为10.9%、19.4%、29.4%(P均<0.01);前循环、后循环、前+后循环脑卒中的SAP发生率分别为8.3%、22.3%、24.6%(P均<0.01);SAP患者的死亡率为31.7%。年龄≥65岁、糖尿病、吸烟史、吞咽障碍、低蛋白血症、预防性应用抗生素、脱水剂、H2受体阻滞剂或质子泵抑制剂、鼻饲治疗为SAP的危险因素。其中,有吸烟史及鼻饲治疗的患者,早发性肺炎的发生率较高(P<0.01)。有低蛋白血症及预防性应用抗生素治疗的患者,晚发性肺炎的发生率更高(P<0.01)。培养出菌株65例,革兰阴性菌67.7%,主要是肺炎克雷伯杆菌;革兰阳性菌26.2%,主要是金黄色葡萄球菌;真菌6.2%,主要是白色假丝酵母菌。结论 SAP多发生在入院72 h内,以革兰阴性菌为主要致病菌;SAP增加患者死亡率;不同卒中类型和部位的SAP发生率不同;早发性肺炎和晚发性肺炎的危险因素不同。

Objective To investigate the incidence, risk factors and the pathogeny of stroke-associated pneumonia （SAP） in acute stroke patients. Methods Clinical data of 642 patients with acute stroke, divided into SAP and non- SAP, were retrospectively analyzed. Univariate analysis and multivariate logistic regression analysis were used to investi- gate related risk factors for SAP. Pathogens of SAP were analyzed. Results The incidence of SAP in 642 patients with acute stroke was 13.2% ,in which early-onset pneumonia（EOP） accounted for 71.8%. Incidences of SAP in the cerebral infarct group, cerebral hemorrhage group and subarachnoid hemorrhage group were 10.9%, 19.4% and 29.4%, respec- tively（P 〈0.01 ）. Incidences of SAP in the anterior circulation group, posterior circulation group and anterior-posterior circulation group were 8.3%, 22.3% and 24.6, respectively（ P 〈 0.01 ）. The mortality of SAP was 31.7%. The risk fac- tors of SAP were age≥65, diabetes, smoking, dysphagia, hypoproteinemia, antibiotic prophylaxis, dehydrant, H2-bloc- ker or inhibitors of proton pumps, and nasal feeding. Patients with smoking and nasal feeding had an increased risk forEOP （P 〈0.01 ）; mose wire nypoprotelnemaa ana antlolOUC prophylaxis nan an lncreaseo riSK for late-onset pneumoma （LOP） （ P 〈 0.01 ）. 65 strains of microorgnisms were obtained by sputum culture. Percentages of the Gram-negative bac- teria, Gram-positive ones, and fungi were 67.7%, 26.2% and 6.2%, respectively. The major strain was K. pneumoniae in Gram-negative bacteria, Enterococcus in Gram-positive bacteria, and Candida albicans in fungi. Conclusions SAP mostly occurs in the first 72 hours of admission, whose major strains are Gram-negative bacteria. The mortality of SAP is quite high in acute stroke. The incidence of SAP is varied in different types and locations. Risk factors are different be- tween EOP and LOP.