老年脑梗死隐性误吸与卒中相关性肺炎临床分析

Silent aspiration and stroke associated pneumonia in senile cerebral infarction

目的 探讨老年脑梗死隐性误吸与卒中相关性肺炎（SAP）的相互关系,为SAP的风险评估与早期干预提供参考指标.方法 对2011年10月至2013年4月在我院神经内科住院的60岁以上急性脑梗死患者100例,在人院后7d内完成吞咽电视荧光透视检查（VFSS）,通过VFSS确定患者有无隐性误吸及其发生率,对隐性与显性误吸患者发生SAP的情况进行比较,分析隐性误吸与SAP的关系.结果 完成VFSS的100例老年患者中,发生误吸46例,其中显性误吸19例,隐性误吸27例,隐性误吸占误吸病例的58.7％; 27例隐性误吸患者的平均年龄为（73.2±5.1）岁,19例显性误吸患者平均为（64.1±4.6）岁,发生隐性误吸的患者年龄高于显性患者;隐性误吸患者74.1％有SAP,而显性误吸患者36.8％有SAP,差异均具有统计学意义（P＜0.05）.结论 脑梗死隐性误吸随年龄增长而增加;隐性误吸比显性误吸更易发生SAP,可能是老年脑梗死SAP的独立危险因素.建议对老年脑梗死早期进行VFSS,及时发现隐性误吸.

Objective To explore the relationship between the silent aspiration in elderly cerebral infarction and stroke associated pneumonia (SAP) and provide some references for the risk assessment and early intervention of SAP.Methods 100 patients over 60 years old and with acute cerebral infarction were selected from the department of neurology of our hospital from August,2011 to April,2013.Videofluoroscopic swallowing study(VFSS) was completed within 7 days after being hospitalized by all the patients.Silent aspiration and its incidence of the patients were determined by VFSS.The differences of SAP between silent aspiration and overt aspiration were compared.The relationship between silent aspiration and SAP was analyzed.Results Among the 100 elderly patients completing VFSS,46 cases occurred aspiration (19 cases were overt aspiration and 27 cases were silent aspiration).The silent aspiration accounted for 58.7％ of the aspiration.The average age of the 27 patients occurring silent aspiration was (73.2 ± 5.1) years,and that of the 19 patients occurring overt aspiration were(64.1 ± 4.6) years old.The patients occurring silent aspiration were older than the patients occurring overt aspiration.The incidence of SAP was higher in the patients occurring silent aspiration than in the patients occurring overt aspiration,with statistical differences (P＜0.05).Conclusions The aspiration rate of acute cerebral infarction increases with age.SAP is more likely to happen in the patients occurring silent aspiration than in the patients occurring overt aspiration.Silent aspiration may be the independent risk factor of SAP in elderly patients with cerebral infarction.VFSS is the most objective evaluation method for silent aspiration.VFSS should be taken by the elderly patients with cerebral infarction of early stage to detect silent aspiration in time.