急性缺血性卒中后肺炎与脑白质疏松症相关性分析

Correlation analysis of pneumonia and leukoaraiosis after acute ischemic stroke

目的探讨急性缺血性卒中后肺炎与脑白质疏松症之间的关系。方法连续纳入2015-01-01—2017-10-31阜新市第二人民医院神经内科发病24h就诊的338例急性缺血性脑卒中患者,死亡4例,338例患者年龄(67.6±8.1)岁,其中男222例(65.7%),女116例(34.3%)。卒中相关性肺炎46例,发生率13.6%,脑白质疏松295例,发生率86.4%。卒中相关性肺炎(SAP)根据改良美国疾病控制预防中心(CDC)定义为卒中后第2天到第7天的下呼吸道感染。脑白质疏松(LA)使用Fazekas量表分别对脑室周围和皮质下区进行评分,轻度LA(0~2分)或严重LA(3~6分),并对统计结果进行统计学分析。结果 338例急性缺血性脑卒中患者,均完成随访,死亡4例。338例患者中SAP 46例(14%),无SAP与有SAP 2组患者在年龄、基线NIHSS评分、心房纤颤、意识障碍、吞咽困难、重度LA和糖尿病上差异有统计学意义。多因素相关分析结果显示,房颤、基线NIHSS、意识障碍、吞咽功能障碍、A2DS2评分(5~10)及重度LA是急性缺血性脑卒中发生SAP的危险因素。结论在本研究中,重度LA是SAP的独立危险因素。

Objective To investigate the relationship between pneumonia and leukoaraiosis after acute ischemic stroke. Methods A total of 338 consecutive patients with acute ischemic stroke admitted to she Fuxin City Second People＇s Hospital from January 1,2015 to October 31,2017 were selected. All patients were admitted within 24 hours after onset and 4 cases died. 338 cases of patients with an average age of 67.6±8.1 years,male 222 cases （65.7%）,female 116 cases （34.3%）. There were 46 cases had stroke associated pneumonia （13.6%）, and 295 cases had leukoaraiosis （86.4%）. Leukoaraiosis （LA） was assessed by Fazekas scale for peripheral ventricular and subcortical areas respectively,mild LA （0 to 2 points） or severe LA （3 to 6 points）, and the results were statistically analyzed. Results Of the 346 patients with acute ischemic stroke,all the patients were followed up and 4 cases died. Of the 346 patients, 46 cases （14%） were SAP. There were significant differences in age, baseline NIHSS score, atrial fibrillation, disturbance of consciousness, clysphagia, severe LA and diabetes between the two groups without SAP and SAP. Multivariate analysis showed that AF, baseline baseline NIHSS, dysphagia, dysphagia, A2DS2 score （5-10） and severe I.A were risk factors for SAP in acute ischemic stroke. Conclusion In this study, severe LA is an independent risk factor for SAP.