脑卒中患者并发吸入性肺炎的危险因素及其预测分析

Risk factors of aspiration pneumonia in patients with stroke and the predictive analysis

目的分析脑卒中患者发生吸人性肺炎的危险因素。方法收集2007年1月1日至2011年IO月31日间我院神经内科收治的314例脑卒中患者的临床资料，依据是否合并AP将患者分为AP组和非AP组，其中AP组和非AP组分别为62例（19．75％）和252例（80．25％）。对所有患者资料进行组间单因素及多因素Logistic回归分析，评价各因素与脑卒中患者发生AP的相关性。结果两组组间资料单因素比较显示年龄、合并基础疾病数量、脑卒中部位位于脑干例数、洼田氏饮水试验分级Ⅳ-Ⅴ级例数、白蛋白、格拉斯哥昏迷评分（Gcs）d,于9分例数，差异有统计学意义（P均〈0．05）。此6项指标经多因素Logistic回归分析结果显示合并基础疾病（OR=1．31，95％CI：1．27-1．34，P〈0．01）、洼田氏饮水试验分级（OR=1．23，95％CI：1．19-1．25，P〈0．01）、GCS（OR=0．87，95％CI：0．83-0．91，P〈0．01）以及脑卒中部位位于脑干（OR=I．37，95％CI：1．26-1．41，P〈0．01）与脑卒中患者发生AP有显著相关性。通过受试者工作特征瞌线（ROC曲线）检验这四个因素对AP发生的预测效能，计算ROC曲线下面积为0．835（P〈0．01，95％CI：0．821-0．846）。结论合并多种基础疾病、洼田氏饮水试验分级过高、GCS过低及脑卒中部位位于脑干增加脑卒中患者发生AP的风险，可作为脑卒中患者发生AP的独立预测因素。

Objective To explore the risk factors of aspiration pneumonia （AP） in patients with stroke. Methods The clinical data of 314 patients with stroke admitted in our hospital from January 1, 2007 to October 31, 2011 were analyzed retrospectively. The patients were divided into two groups： aspiration pneumonia group （AP group, n=62, 19.75%） and no-aspiration pneumonia group （no-AP group, n=252, 80.25%）. Univariate and multivariate logistic regression analysis were performed to evaluate the risk factors of AP in patients with CHF. Results According to the univariate logistic regression analysis, age, the amount of patients complicated with underlying disease, the cases of stroke in brain stem, the patients with the water swallow test classification of IV or V grade, the cases with Glasgow coma score （GCS） less than 9 and album were significantly different between the two groups （P〈0.05）. According to the multivariable logistic regression analysis, complication with underlying diseases （OR=l.31, 95% CI： 1.27-1.34, P〈0.01）, the water swallow test classification （OR=1.23, 95% CI： 1.19-1.25, P〈0.01）, GCS （OR=0.87, 95% CI： 0.83-0.91, P〈0.01） and the stroke in brain stem （OR=1.37, 95% CI： 1.26-1.41, P〈0.01） were significantly correlated to the AP in patients with stroke. The area under the ROC curve was 0.835 （P〈0.01, 95% CI： 0.821-0.846）. Conclusion Complication of underlying diseases, water swallow test classification of IV or V grade, stroke in brain stem and the GCS less than 9 increases the risk of the AP in patients with stroke during hospitalization. The four risk factors are the significant independent predictors for the AP in patients with stroke during hospitalization.