急性脑梗死患者血压对卒中相关性肺炎的影响

Effects of hypertension on stroke-associated pneumonia after acute cerebral infarction

目的研究急性脑梗死患者的血压与卒中相关性肺炎(SAP)的相关性。方法选取2010-03—2013-03在我院诊治的急性脑梗死患者174例,根据患者的血压状况分为血压正常组(31例)、轻度高血压组(27例)、中度高血压组(63例)和重度高血压组(53例);根据患者有无并发卒中相关性肺炎分为卒中相关性肺炎组(46例)和无卒中相关性肺炎组(128例)。比较各组患者的外周血白细胞计数(WBC)、血清C反应蛋白(CRP)、白蛋白、吞咽障碍发生率、收缩压(SBP)、Glasgow昏迷量表(GCS),记录所有患者既往病史,包括吸烟史、饮酒史、既往脑梗死病史、高血压史、糖尿病史、缺血性心脏病史及充血性心力衰竭病史等。结果血压正常组、轻度组、中度组和重度组患者WBC、CRP、GCS评分、吞咽障碍及SAP发生率比较,差异有统计学意义(P<0.05)。SAP与无SAP组SBP、WBC、CRP水平、吸烟史、GCS评分、意识障碍和吞咽障碍发生率比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析发现CRP、WBC以及高血压状况、吸烟史、GCS评分和吞咽障碍是SAP的危险因素,与血压正常组患者相比较,重度高血压组患者发生SAP的风险明显增高(P<0.05)。结论重度高血压是急性脑梗死患者发生卒中相关性肺炎的独立危险因素,为急性脑梗死患者防治SAP发生提供依据。

Objective To investigate the relationship between the blood pressure （BP） and stroke-associated pneumonia （SAP） in patients with acute cerebral infarction.Methods A total of 174 patients with acute cerebral infarction admitted to our hospital from March 2010 to March 2013 were divided ,according to acute blood pressure values ,into normal BP group （with normal BP ,n=31） ,mild group （with mild hypertension ,n=27） ,moderate group （with moderate hypertension ,n=63） ,se-vere group （with severe hypertension ,n=53） ,and divided into SAP group （n=46） and non-SAP group （n=128） based on whether SAP occurred after acute cerebral infarction. Peripheral white blood cell count （WBC） ,C reactive protein （CRP） ,al-bumin （ALB） ,systolic blood pressure （SBP） ,GCS score and dysphagia incidence were compared between different groups and previous histories including smoking ,alcohol ,cerebral infarction ,diabetes ,hypertension ,ischemic heart diseases ,chronic congestive heart failure were recorded.Results There was significant difference in levels of WBC ,CRP and GCS score ,dys-phagia and SAP incidence among normal BP group ,mild group ,moderate group and severe group （P〈0.05）. There was sig-nificant difference in levels of SBP ,WBC ,CRP ,alcohol history ,GCS scores ,disturbance of consciousness and incidence of dysphagia between SAP and non-SAP groups （P〈0.05）. Multivariate logistic regression indicated that serum CRP ,WBC , hypertension ,smoking history ,GCS score and dysphagia were risk factors for SAP.compared with normal BP group ,severe hypertension group had significantly higher risk of SAP （P〈0.05）. Conclusion Severe hypertension after acute cerebral in-farction was an independent risk factor for SAP ,which provided theoretical basis for the prevention and treatment of SAP.