卒中相关性肺炎的诊疗进展

A review on the diagnosis and treatment of stroke-associated pneumonia

脑卒中是具有高发病率、高病死率、高致残率等特点的以局灶性神经功能缺障碍为特征的急性脑血管疾病,其中卒中相关性肺炎(Stroke-associated Pneumonia,SAP)是急性脑卒中患者临床上常见的并发症之一,可导致脑卒中患者不良预后甚至死亡,阻碍患者康复及神经缺损恢复进程,加重诊疗负担,延长其住院时间。不同于其他肺炎,此类肺炎的发病机制、危险因素和神经系统病变导致的机体功能障碍有着紧密联系,意识障碍、吞咽障碍、抗生素、美国国立卫生研究院卒中量表评分及抑酸药物的不合理使用等都是SAP发生的危险因素,多以混合菌多重感染为主,由于该类患者基础疾病较多、住院时间长等因素,脏腑功能、免疫系统渐趋紊乱,预后较差。所以,在SAP预防和治疗中需要特别关注患者的神经功能缺失,针对性制定临床策略。虽然目前已有关于SAP的诊疗指南,但在临床应用上仍存在效果不理想之处,其在中医学上仍着重于中药内治,而在西医上大多预防性应用抗生素,SAP患者的意识障碍、无法咳痰、胸片不容易发现病灶等相关因素,致使SAP的诊断难度较高,如何采取有效的治疗方式以及康复手段仍是临床上需要解决的一大难题。

Stroke is an acute cerebrovascular disease characterized by focal neurological dysfunction with high morbidity,high mortality and high disability rate.Among them,stroke associated pneumonia(SAP)is one of the common clinical complications in patients with acute stroke.It can lead to poor prognosis and even death of stroke patients,hinder the recovery of patients and the recovery process of nerve defects,increase the burden of diagnosis and treatment,and prolong their hospital stay.Different from other pneumonia,the pathogenesis and risk factors of this type of pneumonia are closely related to the body dysfunction caused by nervous system diseases.Consciousness disturbance,dysphagia,antibiotics,National Institutes of Health Stroke Scale(NIHSS)score,and irrational use of acid suppressant drugs are all risk factors for SAP,most of which are mixed bacteria and multiple infections.Due to many basic diseases and long hospital stay,the function of viscera and immune system tend to be disordered,and the prognosis is poor.In the prevention and treatment,special attention should be paid to patients’neurological function loss,and targeted clinical strategies should be formulated.Although there are currently diagnostic and treatment guidelines for SAP,there are still some unsatisfactory results in clinical application.In traditional medicine,it still focuses on internal treatment of Chinese medicine,while most prophylactic antibiotics in western medicine.The difficulty of diagnosis of SAP is relatively high due to related factors such as disturbance of consciousness,inability to cough up sputum,and difficulty in finding lesions on chest radiographs.How to achieve effective treatment and rehabilitation is still a major clinical problem.