卒中相关性肺炎的危险因素研究

Study of the risk factors for stroke-associated pneumonia

目的探讨急性缺血性脑卒中患者发生卒中相关性肺炎(stroke-associated pneumonia,SAP)的危险因素,为临床有效防治SAP提供指导依据。方法回顾性选取2016年11月—2019年11月在四川大学华西医院神经内科及成都市第六人民医院神经内科住院治疗的330例急性缺血性脑卒中患者为研究对象。按照是否发生SAP分为感染组和非感染组,用多因素logistic回归模型分析影响患者发生SAP的危险因素。结果急性缺血性脑卒中患者中发生SAP共计71例,占21.52%。Logistic回归分析显示,年龄≥70岁[比值比(odds ratio,OR)=3.677,95%置信区间(confidence interval,CI)(1.452,9.311),P=0.006]、慢性肺部疾病[OR=4.985,95%CI(1.558,15.952),P=0.007]、意识障碍[OR=7.147,95%CI(1.617,31.587),P=0.009]、球麻痹[OR=5.909,95%CI(2.668,13.089),P<0.001]、使用鼻饲管[OR=7.427,95%CI(1.681,32.812),P=0.008]是急性缺血性脑卒中患者发生SAP的独立危险因素。结论年龄≥70岁、慢性肺部疾病、意识障碍、球麻痹、使用鼻饲管是急性缺血性脑卒中发生SAP的独立危险因素,需加强对这些危险因素的管理,以早期识别SAP高危患者,针对危险因素制定干预策略,从而改善预后。

Objective To explore the risk factors of stroke-associated pneumonia(SAP) in the patients with acute ischemic stroke, in order to provide effective guidance for clinical prevention and treatment. Methods From November2016 to November 2019, 330 patients with acute ischemic stroke admitted to the Department of Neurology of West China Hospital of Sichuan University and the Department of Neurology of the Sixth People’s Hospital of Chengdu were selected as the research object. The clinical data of the patients were analyzed retrospectively. According to whether SAP occurred, they were divided into infected group and non-infected group. Multivariate logistic regression model was used to analyze the risk factors of SAP. Results A total of 71 cases of SAP occurred in patients with acute ischemic stroke, accounting for 21.52%. Logistic regression analysis showed that age≥70 years old [odds ratio(OR)=3.677,95% confidence interval(CI)(1.452, 9.311), P=0.006], chronic lung disease [OR=4.985, 95%CI(1.558, 15.952), P=0.007],disturbance of consciousness [OR=7.147, 95%CI(1.617, 31.587), P=0.009], bulbar palsy [OR=5.909, 95%CI(2.668, 13.089),P<0.001], the use of nasal feeding tube [OR=7.427, 95%CI(1.681, 32.812), P=0.008] were independent risk factors for SAP in patients with acute ischemic stroke. Conclusions Age≥70 years old, chronic lung disease, disturbance of consciousness, bulbar paralysis and use of nasal feeding tube are independent risk factors for SAP. It is necessary to strengthen the management of these risk factors in order to identify high-risk patients with SAP early, and develop intervention strategies for risk factors, so as to improve the prognosis.