急性脑梗死后并发卒中相关性肺炎的危险因素分析

Analysis of related factors of acute ischemic stroke complicated with stroke associated pneumonia

目的探讨急性脑梗死患者卒中相关肺炎(SAP)的危险因素。方法 479例患者分为SAP组(n=239)和无SAP组(n=240)。分析2组性别、年龄、病史(糖尿病、高血压、房颤及冠心病)、吸烟、饮酒、溶栓、肠内营养、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、高密度脂蛋白等差异。多因素Logistic回归模型分析有差异的指标,探讨SAP危险因素。结果单因素分析显示:SAP组和无SAP组在年龄、NIHSS分级、吞咽功能、肢体功能障碍、意识、发声障碍、冠心病、气切或插管、吸烟、高密度脂蛋白、甘油三酯中有统计学差异(P<0.05)。多因素Logistic回归分析显示,意识障碍、肠内营养是SAP独立危险因素(P<0.05)。存活组和死亡组在NIHSS分级、意识、发声障碍、溶栓、血红蛋白、高密度脂蛋白、A2DS2、NHISS、GCS中有统计学差异(P<0.05)。多因素Logistic回归分析显示,吞咽障碍、溶栓、血红蛋白是死亡的独立危险因素(P<0.05)。结论 SAP由多因素介导,意识障碍、肠内营养是其独立危险因素。吞咽障碍、溶栓、血红蛋白是SAP患者死亡独立危险因素。

Objective To investigate the related factors of stroke associated pneumonia(SAP)in patients with acute ischemic stroke.Methods 479 patients were divided into the SAP group(n=239)and the non-SAP group(n=240).Their gender,age,medical history(diabetes,hypertension,atrial fibrillation and coronary heart disease),smoking,drinking,whether to give thrombolysis and enteral nutrition,NIH Stroke Scale(NIHSS)score(GCS),Glasgow coma scale(GCS),serum albumin levels,high-density lipoprotein cholesterol(hdl-c),etc were analyzed.Meanwhile,multivariate Logistic regression model of dichotomous variables was adopted to analyze the indicators with differences and explore the risk factors of SAP.Results Univariate analysis showed that there were statistically significant differences between SAP group and non-sap group in age,NIHSS grading,swallowingdysfunction,limb dysfunction,consciousness disorder,phonation disorder,coronary heart disease,tracheotomy or tracheacannula,smoking,high-density lipoprotein,triglyceride and other factors(P<0.05).Multivariate Logistic regression analysis showed that consciousness disturbance and enteral nutrition were independent risk factors for SAP(P<0.05).There were statistically significant differences in NIHSS grading,consciousness disturbance,phonation disturbance,thrombolysis,hemoglobin,high-density lipoprotein,A2 DS2,NHISS,GCS and other factors between the survival group and the death group(P<0.05).Multivariate Logistic regression analysis showed that swallowing disorders,thrombolysis and hemoglobin were independent risk factors for death(P<0.05).Conclusion SAP is a complication mediated by multiple factors.The presence of consciousness disturbance and enteral nutrient solution are independent risk factors for SAP.Dysphagia,thrombolysis,and hemoglobin are independent risk factors for death in patients with SAP.