急重症脑卒中患者相关性肺炎的危险因素及外周血单核粒细胞计数对其预测价值

摘要

目的：探讨卒中相关性肺炎（SAI）患者的危险因素及外周血单核粒细胞计数对其预测价值。方法入选的病后24 h内入院的急性重症脑卒中患者为研究对象，收集所有研究对象临床资料，分析其相关危险因素，检测1d、2d、7d和14d的单核粒细胞计数，采用接收者工作特征曲线（ ROC）判断单核粒细胞计数对SAI的预测价值。结果①78例研究对象中有31例发生SAI，发病率为39．74％。SAI危险因素中发生肺部感染的相对危险度分析显示，肺部疾病，呛咳症状，美国国立卫生研究院卒中量表（ NIHSS）评分≥12分，急性生理与慢性健康评估Ⅱ（ APACHEⅡ）≥20分，年龄≥65岁，吸烟，昏迷患者发生SAI危险性相对高。78例重症卒中患者中有19例死亡，死亡率为24．35％，其中SAI患者死亡16例，死亡率为84．21％，显著高于非SAI患者死亡率（15．79％），差异有统计学意义（P＜0．05）；②SAI组与非SAI组单核粒细胞计数比较，差异有统计学意义（均P＜0．05）；③生存组和死亡组单核粒细胞计数比较，差异有统计学意义（均P＜0．01）；④对单核粒细胞计数进行ROC曲线分析，入院第2天的单核粒细胞计数对SAI的发生有预测价值。结论急性重症脑卒中患者SAI的发生率和病死率均较高，其危险因素主要为年龄≥65岁，肺部疾病，吸烟，呛咳症状，GCS≤7分， NIHSS≥12分，APACHEⅡ≥20分。其发病后单核粒细胞计数升高明显增加感染易感性，单核粒细胞计数≥0．46×109／L对SAI的发生有一定的预价值。%Objective To explore the risk factors of stroke-associated infection , ( SAI ) and its predictive value from peripheral blood mononuclear cell count .Methods We selected patients with acute severe stroke within 24h after admission, and collected clinical data .We analyzed the related risk factors , and detected 1 d, 2 d, 7 d and 14 d of mononuclear cell count , using the receiver operating characteristic curve ( ROC) judged mononuclear cell countvaluefortheforecastofSAI.Results ①Therewere31casesofSAIinthe78cases,incidenceof39.74%. There were more risk factors of SAI , such as lung disease , choking cough symptoms , the United States National Institutes of Health Stroke Scale ( NIHSS) score 12 points or greater , acute physiology and chronic health evaluationⅡ(APACHEⅡ) 20 points or more, age 65 or higher, smoking, coma SAI.19 cases severe stroke patients were died , the mortality was 24.35%, the death of 16 patients with SAI, mortality was 84.21%, there were significantly higher than that in patients with non SAI mortality rate (15.79%) (P<0.05); ②In the two groups, there were statistically significant for mononuclear cell counts ( all P<0.05);③In the survival group and death group there were statistically significant for mononuclear cell counts ( all P<0.01);④the ROC curve analysis was carried out on the mononuclear cell count, On the 2nd day, the mononuclear cell counts had the predictive value for SAI .Conclusion The patients with acute severe cerebral apoplexy SAI both incidence and case fatality rate is higher .After the onset of mononuclear cell count has certain dynamic change law of mononuclear cell count in SAI has a certain value .