高碳酸血症对脑卒中后肺炎感染程度及预后的影响

Influence of hypercapnia on severity of pneumonia and prognosis of stroke patients

目的 探讨高碳酸血症对脑卒中后肺炎(SAP)患者感染程度及预后的影响。方法 选取2019年1月-2020年12月于北京市大兴区人民医院进行治疗的SAP患者172例,按照入院24 h内动脉血二氧化碳分压(PaCO)水平分为低水平组52例、正常水平组63例、高水平组57例,收集患者基本资料、入院24 h的血常规指标、疾病严重程度相关指标,分析各指标对SAP患者预后的评估效能。结果 入院24 h,与低水平组和正常水平组SAP患者相比,高水平组SAP患者的慢性阻塞性肺疾病(COPD)发生例数、pH<7.35发生例数、肺部感染严重指数评分(PSI)增高(P<0.05),白细胞介素-6(IL-6)、C-反应蛋白(CRP)、降钙素原(PCT)水平降低(P<0.05);入院5 d,高水平组SAP患者的白细胞计数、IL-6、CRP、PCT、乳酸水平较高(P<0.05),氧合指数较低(P<0.05)。高水平组SAP患者有创机械通气比例以及28 d病死例数均高于低水平组和正常水平组,但无统计学差异,三组SAP患者住院时间比较,无统计学差异。结论 患者入院时高碳酸血症与SAP患者有创机械通气以及死亡有一定关系,该结果可能是因为高碳酸血症早期抑制了机体的炎症反应因而引发感染程度加重有关。

OBJECTIVE To explore the influence of hypercapnia on severity of pneumonia and prognosis of the stroke patients. METHODS A total of 172 stroke patients who were treated in Beijing Daxing District People’s Hospital from Jan 2019 to Dec 2020 were enrolled in the study and were divided into the low level group with 52 cases, the normal level group with 63 cases and the high level group with 57 cases according to the partial pressure of arterial carbon dioxide(PaCO) within 24 hours after the admission. The baseline data, blood routine test indexes within 24 hours after admission and related indexes for severity of disease were collected. The efficiencies of the indexes in evaluation of the prognosis of the stroke patients were observed. RESULTS After the admission for 24 hours, the incidence of chronic obstructive pulmonary disease(COPD), incidence of pH less than 7.35 and pneumonia severity index(PSI) score were significantly higher in the high level group than in the low level group and the normal level group(P<0.05);the levels of interleukin-6(IL-6), C-reactive protein(CRP) and procalcitonin(PCT) were lower significantly in the high level group than in the low level group and the normal level group(P<0.05). After the admission for 5 days, the levels of white blood cell, IL-6, CRP, PCT and lactic acid of the high level group were significantly higher than those of the low level group and the normal level group(P<0.05), the oxygenation index of the high level group was significantly lower than that of the low level group and the normal level group(P<0.05). The proportion of the patients who underwent mechanical ventilation and 28-day mortality rate were higher in the high level group than in the low level group and the normal level group, however, there was no significant difference;there was no significant difference in the length of hospital stay among the three groups. CONCLUSION There is certain association between the hypercapnia at the admission and the mechanical ventilation, as well as mortality of the stroke patients, the hypercapnia may inhibit the inflammatory response in early stage so as to lead to the aggravation of infection.