西安地区急性脑梗死合并肺炎患者的临床特征与早期预后分析

Analysis of clinical characteristics and early prognosis in acute cerebral infarction patients complicated with pneumonia in areas of Xi’an city

目的 探讨西安地区急性脑梗死(ACI)合并肺炎患者的临床特征与早期预后情况.方法 通过西安脑卒中数据库平台,收集西安市4家三级甲等医院2015年1-12月连续入院的ACI合并肺炎患者的临床资料,比较分析ACI合并肺炎与未合并肺炎患者的临床特征,记录90 d随访的结局事件(包括卒中复发、死亡和预后不良),通过多因素Logistic回归分析,探讨ACI合并肺炎患者的早期预后情况.结果 本研究最终纳入ACI患者2 137例,其中ACI合并肺炎患者共计104例(占4.87%).与ACI未合并肺炎组患者相比,合并肺炎组患者的平均年龄较高,入院美国国立卫生研究院卒中量表(NIHSS)评分≥14分者占比较高,既往卒中患者占比较高,吞咽评价结果为困难者占比较高,接受吞咽康复者占比较低,心房颤动占比较高,空腹血糖、谷草转氨酶、尿素氮、白细胞水平均较高,差异均有统计学意义(P <0.05或P<0.01).ACI合并肺炎患者的早期预后较差.校正相关混杂因素后,多因素Logistic回归分析显示,ACI合并肺炎患者90 d死亡风险显著升高(OR =3.88,95% CI为1.46 ~ 10.30,P<0.01),早期预后不良风险显著升高(OR=5.45,95% CI为2.60 ~ 11.42,P<0.01),早期卒中复发风险则无显著差异(P>0.05).结论 临床医师需重视老年人群缺血性脑卒中的一级预防,依据本区域的疾病临床特征,积极规范地治疗ACI患者合并的卒中后肺炎,这对于减少早期不良预后结局具有重要意义.

Objective To investigate the clinical characteristics and the early prognosis of acute cerebral infarction(ACI)complicated with pneumonia in areas of Xi′an city.Methods Clinical data of acute cerebral infarction(ACI)patients complicated with pneumonia who were consecutively admitted to four tertiary grade and class A hospitals from January to December 2015 in Stroke Data Bank of Xi′an city were collected,and the clinical characteristics of ACI patients who complicated with and without pneumonia were comparatively analyzed.The outcome events of 90 d follow-up including recurrence of stroke,death and poor prognosis were recorded.Multivariate logistic regression analysis was used to investigate the early prognosis of acute cerebral infarction(ACI)complicated with pneumonia in Xi'an district within 90 d of follow-up.Results A total of 2137 ACI patients were enrolled in our study,including 104 patients(4.87%)complicated with pneumonia.Compared with the ACI patients without pneumonia,the ACI patients who complicated with pneumonia had elder age,higher proportions in patients with National Institute Health Stroke Scale(NIHSS)score≥14 at admission and in those with a history of stroke,dysphagia by swallowing evaluation results as well as atrial fibrillation,lower proportion in those receiving swallow rehabilitation,and higher fasting blood glucose level,aspartate transaminase,urea nitrogen levels,and leucocyte count levels,there were significant differences between the two groups(P<0.05 or P<0.01).The ACI patients who complicated with pneumonia had worse prognosis of 90 d followed-up than that in patients without pneumonia.After adjustment for therelated confounders,multivariate Logistic regression analysis showed that the risk of 90 d death of followed-up in the ACI patients who complicated with pneumoniwas significantly increased(OR=3.88;95%CI:1.46~10.30,P<0.01),the risk of early poor prognosis was significantly increased(OR=5.45;95%CI:2.60~11.42,P<0.01).There were no obvious differences in early recurrence of stroke between two groups(P>0.05).Conclusion Physicians should focus on the primary prevention of stroke in the elderly.According to the clinical characteristics of this district,it is of great significance to treating the post-stroke pneumonia in ACI patients to reduce early unfavorable prognosis.