脑卒中后吞咽障碍患者发生相关性肺炎的危险因素分析

Risk factors of stroke-associated pneumonia in elderly post-stroke patients with dysphagia

目的:探讨康复期的老年缺血性脑卒中后吞咽障碍患者发生脑卒中相关性肺炎(SAP)的危险因素。方法:脑卒中后吞咽障碍患者148例,回顾性分析患者年龄、性别、糖尿病和房颤病史、鼻胃管进食、构音障碍、肺炎、改良Barthel指数、脑卒中分类、外周血淋巴细胞计数,用多因素Logistic回归探讨发生SAP的相关影响因素。结果:148例中发生SAP感染56例(37.8%),未发生SAP感染92例;通过多因素Logistic回归调整年龄和性别等因素后发现,误吸、年龄≥75岁、男性、糖尿病、房颤是康复期老年脑卒中后吞咽障碍患者SAP的独立危险因素(P<0.01,0.05),外周血淋巴细胞计数高是其保护因素(P<0.05)。此外鼻胃管进食、构音障碍也是该类患者SAP发生的影响因素(P<0.01,0.05)。结论:老年脑卒中后吞咽障碍患者发生SAP的风险值得关注,通过对这一系列危险因素的筛查和监控,可提高医院和家庭对康复期老年脑卒中后吞咽障碍患者的重视程度,改善其预后。

Objective：Elderly post-stroke patients with dysphagia are particularly vulnerable to stroke-associated pneumonia （SAP）.A retrospective evaluation was undertaken to explore the risk factors of SAP.Methods：We retrospectively reviewed the patients＇ database from rehabilitation department to identify ischemic stroke patients within 1 year who developed dysphagia after stroke,but were free of other confounding conditions affecting swallowing.Of the 297 screened,148 met the study criteria.We assessed the effects of age,sex,dysarthria,nasogastric feeding,aspiration pneumonia,stroke subtype,diabetes,atrial fibrillation,modified Barthel index,and lymphocyte counts in a logistic regression analysis.Results：In a multivariate analysis,aspiration detected on a clinical water swallowing evaluation,male gender,age≥75years,diabetes,atrial fibrillation,and lymphocyte counts were independent risk factors of SAP in elderly post-stroke patients with dysphagia （P＜0.05 for all）.Further,dysarthria and nasogastrie feeding were the influecing factors of SAP in elderly post-stroke patients with dysphagia （P＜0.01 or ＜0.05）.Conclusion：Risk factors influencing SAP identified in this study can help advance screening methodologies and the prevention of SAP in elderly post-stroke patients with dysphagia.