急性脑出血患者卒中相关性肺炎发病的危险因素分析

Risk factors lead to stroke-associated with pneumonia in acute cerebral hemorrhage of patients

目的：探讨急性脑出血患者卒中相关性肺炎（ SAP ）发生的危险因素，以便早期干预。方法选择急性脑出血患者196例为研究对象，其中发生SAP 82例为病例组，未发生SAP 114例为对照组。对两组的年龄、性别、心肺疾病史、GCS评分、吞咽困难、心率、血压、白细胞计数、脑出血量、鼻饲、使用胃黏膜保护剂和手术等共计23项予以比较分析。所得资料在单因素分析的基础上，又作多因素Logistic回归分析。结果急性脑出血SAP的患病率为41．837％。收缩压升高（优势比1．072，95％可信区间1．007～1．141，P＝0．029）、白细胞计数增加（优势比1．331，95％可信区间1．009～1．756，P＝0．043）、脑出血量增多（优势比1．079，95％可信区间1．019～1．142，P＝0．010）、有心肺疾病（优势比12．275，95％可信区间1．210～124．545，P＝0．034）、吞咽困难（优势比12．937，95％可信区间1．918～87．250，P＝0．009）和鼻饲（优势比19．217，95％可信区间1．307～282．651，P＝0．031）均促进发病。而使用胃黏膜保护剂（优势比0．157，95％可信区间0．031～0．790，P＝0．025）和实施手术（优势比0．012，95％可信区间0．000～0．294，P＝0．007）阻止发病。结论收缩压、白细胞计数增加、脑出血量增高、有心肺疾病、吞咽困难和鼻饲是急性脑出血发生SAP的危险因素；而使用胃黏膜保护剂和实施手术为其保护因素。

Objective To explore the risk factors of stroke associated with pneumonia （ SAP ） on acute cerebral hemorrhage patients.Methods It focused on 196 acute cerebral hemorrhages of patients who were continuous hospital care and there were 82 cases belong to SAP as compared to 114 unoccurred SAP cases.This study involved in a total of 23 factors, such as ages, sexual, smoking history, hearts and lung disease, Glasgow Coma Scale （ GCS） score, dysphagia, heart rate, systolic pressure, diastolic pressure, numeration of leukocyte, amount of bleeding, nasal feeding, aspiration of sputum, use protective agent of gastric mucosa and surgery.In order to analyse those considerable factors, it not only based on single factor but also applied logistic regression analysis that were conceraed with multiple factors.Rseults There was 41.837 percentages of SAP diseases in acute cerebral hemorrhage of patients.And then the six factors including systolic pressure increased by（ OR=1.07,the confidence of 95%1.007 ~1.141,P=0.03）; numeration of leukocyte increased by（ OR=1.33,the confidence of 95%1.009~1.756,P=0.04）; amount of bleeding increased by（OR=1.08, the confidence of 95%1.019~1.142,P=0.01）;hearts and lung disease（ OR=12.275,the confidence of 95%1.210~124.545,P=0.03）; dysphagia（ OR=12.937, the confidence of 95%1.918~87.250 ,P=0.009） and nasal feeding（ OR=19.217 ,the confidence of 95%1.307~282.651,P=0.031） , risker than those people who didn＇t have those disease.However, there were another other two factor including protective agent of gastric mucosa （ OR=0.157,the confidence of 95%0.031~0.790,P=0.03） and surgery（OR=0.012, the confidence of 95%0.000~0.294,P=0.01）, And it could be said that those two factors preventese disease.Conclusion There are six factors may considered as risk factors for SAP in acute cerebral hemorrhage, including the increased of systolic pressure, numeration of leukocyte and amount of bleeding;hearts and lung disease, dysphagia and nasal feeding.Nevertheless, the patients use protective agent of gastric mucosa and surgery are considered as protective factors.