急性脑卒中患者发生卒中相关性肺炎的影响因素分析

Analysis of influencing factors for stroke-associated pneumonia in patients with acute cerebral stroke

目的探讨急性脑卒中(ACS)患者发生卒中相关性肺炎(SAP)的影响因素及其病原学特征。方法214例ACS患者分为SAP组(95例)和非SAP组(119例)。比较两组相关资料,包括美国国立卫生研究院卒中量表(NIHSS)评分、急性生理与慢性健康状况(APACHEⅡ)评分、GCS评分以及实验室检查指标。采用多因素logistic回归分析ACS患者发生SAP的影响因素,绘制ROC曲线评估中性粒细胞与淋巴细胞比值(NLR)和APACHEⅡ评分对发生SAP的诊断价值,并分析SAP患者痰培养的病原菌情况以及临床结局。结果与非SAP组相比,SAP组患者年龄、APACHEⅡ评分、NIHSS评分、白细胞计数、中性粒细胞计数、中性粒细胞百分比、NLR、血同型半胱氨酸水平以及入住ICU、心房颤动、意识障碍、吞咽困难、留置尿管、留置胃管、深静脉置管、行急诊手术、使用质子泵抑制剂患者比例均增加,GCS评分、淋巴细胞计数以及血红蛋白、白蛋白水平降低(P<0.05)。白蛋白水平增加是ACS患者发生SAP的独立保护因素(P<0.05),而留置尿管或胃管、APACHEⅡ评分和NLR增加是其独立危险因素(P<0.05)。相较于NLR或APACHEⅡ评分单独检测,NLR联合APACHEⅡ评分诊断ACS患者发生SAP的AUC最高(P<0.05)。病原菌分析显示,SAP组有30例(31.58%)患者检出病原菌,其中革兰阴性杆菌18例,以肺炎克雷伯菌为主。SAP组病死率高于非SAP组(27.37%vs.1.68%)(P<0.05)。结论留置尿管或胃管、白蛋白水平降低、APACHEⅡ评分和NLR增加是ACS患者发生SAP的独立危险因素;联合检测APACHEⅡ评分和NLR有助于提高SAP的诊断。

Objective To investigate the influencing factors and etiological characteristics of stroke-associated pneumonia(SAP)in the patients with acute cerebral stroke(ACS).Methods A total of 214 patients with ACS were divided into two groups of A(with SAP,95 cases)and B(without SAP,119 cases).The relevant data,including NIHSS score,APACHEⅡscore,GCS score and laboratory indexes were compared between the two groups.The influencing factors for SAP in the patients with ACS were analyzed by multivariate logistic regression.The diagnostic value of NLR and APACHEⅡscore in SAP was analyzed by ROC curve.The pathogenic bacteria in the sputum culture and clinical outcome of SAP patients were analyzed.Results Compared with group B,the age,APACHEⅡscore,NIHSS score,WBC,neutrophil count,neutrophil percentage,NLR,homocysteine level and proportions of admitting ICU,atrial fibrillation,disturbance of consciousness,dysphagia,indwelling urinary catheter,indwelling gastric tube,deep vein catheterization,emergency operation and using proton pump inhibitor were increased,while GCS score,lymphocyte count and levels of hemoglobin and albumin were decreased in group A(P<0.05).The multivariate logistic regression analysis showed that the increased albumin level was the independent protective factor(P<0.05),while the indwelling urinary catheter,indwelling gastric tube and increased APACHEⅡscore and NLR were the independent risk factors for SAP in the patients with ACS(P<0.05).Compared with NLR or APACHEⅡscore alone,the AUC value of combined detection of them in the diagnosis of SAP in the patients with ACS was higher(P<0.05).The pathogen analysis showed that the pathogenic bacteria was found in 30 cases(31.58%)in group A,which included 18 cases of Gram-negative bacilli,mainly Klebsiella pneumoniae.The mortality rate in group A was higher than that in group B(27.37%vs.1.68%)(P<0.05).Conclusion The indwelling catheter,indwelling gastric tube,decreased albumin level,and increased APACHEⅡscore and NLR are the independent risk factors for SAP in the patients with ACS.The combined detection of APACHEⅡscore and NLR may improve the diagnosis of SAP.