老年卒中相关性肺炎发生及预后的临床探讨

Clinical analysis of the occurrence and prognosis of the stroke-associated pneumonia in the elderly patients

目的:探讨影响老年卒中相关性肺炎(SAP)发生与预后的相关因素。方法:回顾性分析近5年(2006～2011年)因脑卒中急诊住院的老年患者共计839例(年龄>60岁),对于其中出现卒中相关性肺炎的147例患者的临床特点进行分析。结果:发生卒中相关性肺炎的老年患者住院时间和病死率为(27±6)d和38.2%,而未发生卒中相关性肺炎的老年患者分别为(12±5)d和12.5%,两者比较统计学有显著差异。卒中相关性肺炎的发生和预后与多种因素(原发基础病、意识障碍、呛咳等)密切相关。其中肺炎克雷伯菌、金黄色葡萄球菌、鲍曼不动杆菌、大肠埃希氏菌、铜绿假单胞菌是主要的致病菌。结论:对导致老年卒中相关性肺炎的因素(原发基础病、意识障碍、呛咳等)进行控制,可以改善老年卒中相关性肺炎患者的预后。

Objective：To investigate the factors affecting the occurrence and prognosis of stroke-associated pneumonia（SAP） in elderly patients.Methods：Between 2006 and 2011,839 elderly patients（〉60 years old）with emergency stroke were treated on hospitalization basis,among whom 147 were identified as SAP and analyzed retrospectively for the clinical features.Results：The hospital stay for the elderly patients with SAP was（27 ± 6） days and case fatality rate was 38.2% compared to（12 ± 5） days and 12.5%,respectively,in those without SAP.The two groups were statistically different.The occurrence and prognosis of SAP were involved in a variety of factors,including presence or absence of primary underlying diseases and occurrence of coma and choking cough,and the major pneumonia pathogens were associated with Klebsiella pneumoniae,staphylococcus aureus,Acinetobacter baumannii,Escherichia coli,and Pseudomonas aeruginosa.Conclusion：Well management of the factors responsible for SAP may lead to better prognosis in such elderly patients.