急性缺血性脑卒中并发卒中相关性肺炎的多因素分析

Analysis of Acute Ischemic Stroke Complicated with Stroke-associated Pneumonia

目的:探讨急性缺血性脑卒中(AIS)患者卒中相关性肺炎(SAP)的危险因素。方法:180例AIS患者分为SAP组(n=85)和非SAP组(n=95);采用单因素分析法分析2组患者性别、年龄、既往病史(糖尿病、高血压、房颤及冠心病)、生活习惯(吸烟、饮酒)、入院后是否予以肠内营养(EN)、每日EN总量及EN时长、入院时神经功能缺损评分(NIHSS)、格拉斯哥昏迷量表评分(GCS)、血清白蛋白(Alb)水平,采用二分类变量多因素Logistic回归模型对有差异的指标进行分析,探讨SAP的危险因素。结果:单因素分析结果显示,SAP组和非SAP组患者在入院时NIHSS≥15分、入院时GCS≤11分、入院时血清白蛋白<35 g/L、给予EN、给予机械通气、有吸烟史、房颤史、糖尿病史等因素比较,差异有统计学意义(P<0.05);多因素Logistic回归分析结果显示,入院时NIHSS≥15分、入院时GCS≤11分、糖尿病、吸烟、机械通气及EN是SAP的独立危险因素(P<0.05)。结论:SAP是多因素介导的并发症,入院时NIHSS≥15分、入院时GCS≤11分、糖尿病、吸烟、EN及机械通气是AIS患者发生SAP的独立危险因素。

Objective:To study the risk factors of stroke-associated pneumonia(SAP) in patients with acute ischemic stroke(AIS).Methods:180 patients with AIS were divided into SAP group(n=85) and non-SAP group(n=95).Univariate analysis was used to analyze gender,age,past medical history(diabetes,hypertension,atrial fibrillation and coronary heart disease),lifestyle(smoking,drinking),enteral nutrition(EN) after admission,total daily EN and EN duration,admission neurological impairment score,(NIHSS),Glasgow coma scale(GCS),and serum albumin(Alb) level.The multivariate Logistic regression model of two classification variables was used to analyze the different indexes and discuss the risk factors of SAP.Results:Univariate analysis showed that NIHSS≥15 on admission,GCS≤11 on admission,serum albumin<35g/L on admission,EN,mechanical ventilation,history of smoking,history of atrial fibrillation and history of diabetes were compared between SAP group and non-SAP group,and the difference was statistically significant(P<0.05).Multivariate Logistic regression analysis showed that NIHSS≥15 on admission,GCS≤11 on admission,diabetes,smoking,mechanical ventilation and EN were independent risk factors for SAP(P<0.05).Conclusions:SAP is a multifactorial complication.NIHSS≥15 at admission,GCS≤11 at admission,diabetes,smoking,EN and mechanical ventilation are independent risk factors for SAP in AIS patients.