老年脑卒中患者后遗症期反复并发肺炎的危险因素及预后分析

Analysis of risk factors and prognosis of pneumonia in elderly patients of cerebral stroke sequelae period

目的 分析老年脑卒中患者后遗症期反复并发肺炎的危险因素与预后.方法 选择老年脑卒中后遗症期反复并发肺炎的患者作为脑卒中组,与同期住院的非脑卒中老年肺炎患者1∶1配对,组成对照组,分析老年脑卒中患者后遗症期反复并发肺炎的危险因素及预后.结果 脑卒中组反复并发肺炎与高血压、糖尿病、意识障碍、呛咳与鼻饲、肢体运动障碍、气管切开、多器官功能障碍综合征（MODS）、住院次数、住院时间、放弃治疗或死亡情况有关（P＜0.05）,而与吸烟、冠心病、肾功能不全、恶性肿瘤、痰培养阳性、低氧血症、机械通气无关（P＞0.05）；有条件Logistic回归分析支持上述结果；二分类无条件Logistic回归分析提示影响死亡的独立因素为呛咳与鼻饲及MODS.结论 高血压、糖尿病、意识障碍、呛咳与鼻饲、肢体障碍、气管切开、MODS、住院次数是老年脑卒中患者后遗症期反复并发肺炎的高危因素,而且相对预后不良,应针对此进行有效的三级防控.

Objective To investigate the risk factors and prognosis of pneumonia in elderly patients of cerebral stroke sequelae period. Methods Eighty-eight cases of pneumonia in elderly patients with cerebral stroke sequelae period were selected as stroke group,with non-stroke patients of the same period suffering from pneumonia 1 ： 1 matched as control group. The risk factors and prognosis of pneumonia in elderly patients of cerebral stroke sequelae period were analyzed. Results Pneumonia in stroke group was related with hypertension,diabetes,conscious disturbance,bucking or nasogastric feeding,dyscinesia, incision of trachea, multiple organ disfunction syndrome （MODS）, hospitalizations, hospital stay and abandon treatment or death （P 〈 0.05）, and not related with smoking, coronary heart disease, kindey dysfunction, malignant tumor, phlegm bacterial culture, hypoxemia and mechanical ventilation was tested by conditioned Logistic regression quantitatively（P 〉 0.05 ）. The independent risk factors for pneumonia in elderly patients of cerebral stroke sequelae period were bucking or nasogastric feeding, and MODS by two-way unconditional Logistic regression. Conclusions Hypertension,diabetes,conscious disturbance,bucking or nasogastric feeding,dyscinesia,incision of trachea, MODS,hospitalizations are risk factors for pneumonia in elderly patients of cerebral stroke sequelae period, and lead to relatively poor prognosis. Three-grade prevention and control of risk factors can improve prognosis.