早期预防性应用抗生素对急性重症缺血性脑卒中患者的影响

Effect of preventive antibacterial therapy in acute severe ischemic stroke

目的探讨急性重症缺血性脑卒中患者早期预防性应用抗生素对卒中相关性肺炎(SAP)及卒中患者转归的影响.方法前瞻性收集急性重症缺血性脑卒中患者156例,随机分为抗感染组(n=77)与对照组(n=79).比较2组SAP发生率、住院时间、出院时NIHSS评分以及30 d病死率.观察并记录所有SAP患者的病原菌分布情况.采用改良Rankin量表(mRS)评价患者90 d的神经功能转归,预后良好为m RS评分0~2分,比较2组90 d预后良好比例.出院后进行为期6个月的随访,采用Kaplan-Meier生存曲线比较2组生存率.结果抗感染组SAP发生率显著低于对照组(25.4%vs 44.8%,P<0.05).病原菌分布主要以革兰阴性杆菌为主.抗感染组住院时间、出院NIHSS评分、30 d病死率与对照组比较,差异无统计学意义(P>0.05).抗感染组90 d预后良好比例显著高于对照组(41.8%vs 25.4%,P<0.05).6个月随访结束时12例(9.6%)死亡,其中抗感染组4例,对照组8例.Kaplan-Meier分析表明,2组6个月生存率差异无统计学意义(Log-Rank检验,P>0.05).结论早期预防性应用抗生素可减少急性重症缺血性脑卒中患者SAP发生率且能增加预后良好比例.

Objective To investigate whether or not preventive antibacterial therapy reduces stroke associated pneumonia (SAP) and improves functional outcome in patients with acute severe ischemic stroke. Methods A total of 156 patients with acute severe ischemic stroke were enrolled and were randomly divided into antibiotics group ( n =77) and control group ( n =79).The incidence of SAP,pathogenic bacteria of SAP,length of hospitalization,NIHSS score at discharge and 30d mortality of both group were recorded.The neurological outcome measure was the score on modified Rankin scale (mRS) at 90d dichotomised between favourable (0-2) and unfavourable (>2) outcome.All patients in both group were followed up for 6 months after discharge.Kaplan Meier survive curve was used to compare the survival rate of both group. Results The incidence of SAP was significantly lower in antibiotics group than in control group (25.4% vs 44.8%, P <0.05).The length of hospitalization,NIHSS score at discharge and 30d mortality between antibiotics group and control group were not statistically significant ( P >0.05).Compared with the control group,the proportion of 90d favourable outcome in antibiotics group significantly increased (41.8% vs 25.4%, P <0.05).At the end of the 6 month follow up period,a total of 13 patients (9.6%) died,including 4 in the antibiotics group and 8 in the control group.The Kaplan Meier analysis showed that there was no significant difference in the 6 month survival rate between the two groups ( P >0.05). Conclusion Preventive antibacterial therapy reduces stroke associated pneumonia (SAP) and improves functional outcome in patients with acute severe ischemic stroke.