急性缺血性卒中后肺炎的危险因素及远期预后分析

Risk factors and long-term effects of post-stroke pneumonia in acute ischemic stroke patients

目的探讨急性缺血性卒中后肺炎发生的危险因素及远期预后。方法收集544例急性缺血性卒中患者的临床资料,分析发生卒中后肺炎的相关危险因素并评估其对远期预后的影响。结果卒中后肺炎组年龄≥80岁、高血压、心房纤颤、既往卒中或TIA史、慢性呼吸系统疾病、合并恶性肿瘤、NIHSS评分≥15分、GCS评分≤8分、卧床时间≥7 d、吞咽障碍、早期鼻饲、早期应用质子泵受体阻滞剂、早期应用糖皮质激素、基线空腹血糖≥7.0 mmol/L、低蛋白血症、贫血的比率均显著高于无肺炎组;早期康复治疗的比率明显低于无肺炎组(均P<0.05)。Logistic回归分析显示,年龄≥80岁、NIHSS评分≥15分、GCS评分≤8分、卧床时间≥7 d、吞咽障碍、基线空腹血糖≥7.0 mmol/L、低蛋白血症是卒中后肺炎的独立危险因素,早期康复治疗是卒中后肺炎的保护因素。卒中后肺炎组患者预后良好的比率显著低于无肺炎组(P<0.05)。结论年龄≥80岁、NIHSS评分≥15分、GCS评分≤8分、卧床时间≥7 d、吞咽障碍、基线空腹血糖≥7.0 mmol/L、低蛋白血症是卒中后肺炎发生的独立危险因素。卒中后肺炎是导致预后不良的重要影响因素。

Objective To investigate the risk factors and long-term effects of post-stroke pneumonia in acute ischemic sroke patients. Methods Clinical date of 544 patients with acute ischemic stroke were collected.According to the results of single-factor analysis,multi-factor no-conditional logistic regression model was performed to identify the independent risk factors. Further long-term effects of post-stroke pneumonia was analysised in acute ischemic stroke patients. Results In post-stroke pneumonia group,the rates of age ≥ 80 years,hypertension,fibrillation atrial,history of stroke or TIA,chronic respiratory disease,malignant tumor,NIHSS≥15,GCS≤8,stay in bed≥7 d,disturbances in swallowing,and indwelling gastric tube,application of proton pump receptors inhibitors and glucocorticoidin early stage,baseline fasting plasma glucose ≥ 7. 0 mmol / L,hypoproteinemia,anemia were significantly higher than those in no pneumonia group; the rate of early rehabilitation was significantly lower than that in no pneumonia group（ all P〈0. 05）. Logistic regression showed age≥80 years,NIHSS≥15,GCS≤8,stay in bed≥7 d,disturbances in swallowing,baseline fasting plasma glucose ≥7. 0 mmol / L,hypoproteinemia were the independent risk factors of acute post-stroke pneumonia,early rehabilitation was the protection factor of post-stroke pneumonia. The prognosis of patients with post-stroke pneumonia was significantly weaker than that in no pneumonia group（ P〈0. 05）. Conclusions Age ≥ 80 years,NIHSS ≥ 15,GCS ≤ 8,stay in bed ≥ 7 d,disturbances in swallowing,baseline fasting plasma glucose ≥ 7. 0 mmol / L,hypoproteinemia are the risk factors of post-stroke pneumonia. Post-stroke pneumonia is an important factor affecting the prognosis.