老年首发脑梗死患者卒中相关性肺炎发生的危险因素及对早期结局的影响

Risk factors of stroke-associated pneumonia in elderly patients with first-onset cerebral infarction and its impact on early outcome

目的探讨老年首发脑梗死患者卒中相关性肺炎(stroke associated pneumonia,SAP)发生的危险因素以及其对早期结局的影响。方法通过西安卒中登记研究,纳入西安市4所三级甲等医院收治的老年首发脑梗死患者,根据院内是否发生SAP分为非SAP组和SAP组,比较2组患者的基线临床特征差异。采用多变量Logistic回归模型分析老年首发脑梗死患者SAP发生的危险因素以及SAP发生对患者早期结局事件[转归不良(mRS评分:3~6分)、卒中复发和死亡]的影响。结果共纳入老年首发脑梗死患者1039例,平均年龄(71.58±7.62)岁,男性577例(55.5%),发生SAP 64例(6.2%)。多变量Logistic回归模型分析结果显示:年龄(OR=1.073,95%CI:1.025~1.123,P<0.001)、入院国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分(OR=1.114,95%CI:1.047~1.186,P<0.001)、吞咽障碍(OR=3.042,95%CI:1.523~6.084,P=0.002)及白细胞计数(OR=1.153,95%CI:1.023~1.299,P=0.020)是老年首发脑梗死患者SAP发生的独立危险因素。SAP发生与更高的早期转归不良(OR=3.194,95%CI:1.516~6.730,P=0.002)、卒中复发(OR=3.368,95%CI:1.271~8.926,P=0.015)和死亡(OR=2.706,95%CI:1.111~6.588,P=0.028)事件风险相关。结论年龄、入院NIHSS评分、吞咽困难及白细胞计数是老年首发脑梗死患者SAP发生的独立危险因素。SAP发生显著增加该类患者早期不良预后风险。

Objective To investigate the risk factors of stroke-associated pneumonia(SAP)and its impact on early outcome in elderly patients with first-onset cerebral infarction(CI).Methods According to the Xi′an Stroke Registration Study,the elderly patients with first-onsetCI admitted to four first-class tertiary hospitals in Xi′an City were included.They were divided into non-SAP group and SAP group based to the occurrence of SAP in hospital,and the differences in baseline clinical characteristics of the two groups were compared.Multivariate Logistic regression model was used to analyze the risk factors for SAP and its impact on early outcome events(poor outcome[mRS score:3-6 points],stroke recurrence and death)in elderly patients with first-onset CI.Results A total of 1039 patients with first-onset CI were enrolled in the study,with an average age of(71.58±7.62)years,including 577 males(55.7%)and occurrence of SAP in 64 cases(6.2%).Multivariate Logistic regression model showed that age(OR=1.073,95%CI:1.025-1.123,P<0.001),National Institutes of Health Stroke Scale(NIHSS)score on admission(OR=1.114,95%CI:1.047-1.186,P<0.001),dysphagia(OR=3.042,95%CI:1.523-6.084,P=0.002)and white blood cell(WBC)count(OR=1.153,95%CI:1.023-1.299,P=0.020)were independent risk factors for SAP in elderly patients with first-onset CI.The incidence of SAP was associated with a higher risk of early poor outcome(OR=3.194,95%CI:1.516-6.730,P=0.002),stroke recurrence(OR=3.368,95%CI:1.271-8.926,P=0.015)and death(OR=2.706,95%CI:1.111-6.588,P=0.028).Conclusion Age,NIHSS score on admission,dysphagia and WBC count are independent risk factors for SAP in elderly patients with first-onset CI.The occurrence of SAP significantly increases the risk of poor early prognosis in these patients.