肺部细菌感染评分用于大面积脑梗死并发吸入性肺炎患者预后评估的研究

The influence of the pulmonary bacterial infection score on the prognosis for patients with large hemispheric infarction and aspiration pneumonia

目的探讨肺部细菌感染评分(CPIS)对大面积脑梗死(LHI)并发吸入性肺炎患者预后的评估价值。方法 2018年1月-2020年12月本院收治的LHI合并吸入性肺炎患者116例,均根据自身情况选择合适营养方式,住院31~97 d,依据住院后生存状况分为死亡组和生存组。收集患者的性别、年龄、既往病史、饮酒、吸烟、入院收缩压及美国国立卫生研究院卒中量表(NIHSS)评分,入院24 h血常规、肾功能指标、血糖、血脂等资料,根据简化的CPIS标准对其中的体温、气管分泌物、氧和指数、胸部X线片等进行评分,采用Logistic回归分析法分析影响LHI合并吸入性肺炎患者死亡的危险因素;绘制受试者工作特性曲线(ROC),分析CPIS对LHI合并吸入性肺炎患者死亡的诊断价值。结果 116例患者LHI合并吸入性肺炎患者住院期间生存91例(78.45%),死亡25例(21.55%)。与生存组相比,死亡组入院NIHSS评分、肌酐、胱抑素C、CPIS均升高(均P<0.05)。Logistic回归分析显示,胱抑素C、CPIS是影响LHI合并吸入性肺炎患者死亡的危险因素(均P<0.05)。ROC曲线显示,CPIS预测LHI合并吸入性肺炎患者死亡的ROC曲线下面积为0.857,截断值为6.13,敏感性为82.89%,特异性为80.21%。结论 LHI并发吸入性肺炎死亡患者CPIS升高,是影响患者死亡的独立危险因素,且对患者的预后评估具有一定参考价值。

Objective To evaluate the Clinical Pulmonary Infection Score(CPIS) of patients with large hemispheric infarction(LHI) and aspiration pneumonia and to explore its relationship with prognosis. Methods Subjects were a total of 116 patients with LHI and aspiration pneumonia seen at this Hospital from January 2018 to December 2020. Appropriate methods of nutrition were selected for patients in accordance with their condition, and patients were hospitalized for 31-97 days. Patients were divided into those who died and those who survived in accordance with their status after hospitalization. General information was collected, including sex, age, past medical history, drinking, smoking, systolic blood pressure on admission and the National Institutes of Health Stroke Scale(NIHSS) score, routine blood results, indicators of renal function, blood glucose, and blood lipids 24 hours after admission. All patients were scored in accordance with the simplified CPIS criteria. Logistic analysis was used to analyze the risk factors influencing the death of patients with LHI and aspiration pneumonia. A receiver operating characteristic curve(ROC) was plotted to analyze the diagnostic value of CPIS in predicting the death of patients with LHI and aspiration pneumonia. Results Of 116 patients hospitalized with LHI and aspiration pneumonia, 91 survived(78.45%) and 25 died(21.55%). Compared to patients who survived, the NIHSS score, creatinine level, cystatin C level, and CPIS on admission increased in patients who died(P<0.05). Logistic regression analysis indicated that cystatin C and CPIS were risk factors for the death of patients with LHI and aspiration pneumonia. The ROC curve indicated that the area under the ROC curve for CPIS to predict death was 0.857, its cut-off value was 6.13, its sensitivity was 82.89%, and its specificity was 80.21%. Conclusion The CPIS increased in patients who died of LHI and aspiration pneumonia. The CPIS was an independent risk factor for the death of patients, and it has a certain diagnostic value in terms of predicting the death of patients. Attention should be paid to the CPIS in clinical practice.