急性脑梗死患者并发卒中相关性肺炎的危险因素研究

摘要

目的：探讨急性脑梗死患者并发卒中相关性肺炎（SAP）的危险因素。方法连续收集2013年5月—2015年5月在武汉市中心医院神经内科普通病房和重症监护病房（ICU）住院的急性脑梗死患者1244例，其中发生SAP 286例（观察组），未发生 SAP 958例（对照组）。收集患者基线资料，包括人口学特征、实验室检查结果及临床特征，并对急性脑梗死患者并发 SAP 的影响因素进行多因素非条件 logistic 回归分析。结果本组急性脑梗死患者 SAP发生率为22.99%。单因素分析结果显示，两组患者年龄≥70岁者所占比例，既往史〔高血压、冠心病、心房纤颤、慢性阻塞性肺疾病（COPD）〕阳性率，尿蛋白阳性率，非腔隙性脑梗死、吞咽困难、意识障碍、幕下脑梗死、出血性转化、应激性溃疡发生率，鼻饲支持率及血清清蛋白水平、空腹血糖比较，差异有统计学意义（P ﹤0.05）。多因素非条件 logistic 回归分析结果显示，年龄≥70岁〔OR ＝3.650，95% CI（2.236，5.960）〕、有 COPD 病史〔OR ＝18.513，95% CI（9.359，36.623）〕、非腔隙脑梗死〔OR ＝2.453，95% CI（1.507，3.997）〕、吞咽困难〔OR ＝2.875，95% CI （1.616，5.114）〕、鼻饲支持〔OR ＝19.559，95% CI（9.121，41.942）〕、意识障碍〔OR ＝3.487，95% CI（1.882，6.463）〕、幕下脑梗死〔 OR ＝2.011，95% CI （1.090，3.710）〕、出血性转化〔 OR ＝3.411，95% CI （1.866，6.237）〕、应激性溃疡〔OR ＝13.658，95% CI（5.995，31.326）〕是急性脑梗死患者并发 SAP 的独立危险因素（P ﹤0.05）。结论年龄≥70岁、有 COPD 病史、非腔隙性脑梗死、吞咽困难、鼻饲支持、意识障碍、幕下脑梗死、出血性转化、应激性溃疡是急性脑梗死患者并发 SAP 的独立危险因素，低水平血清清蛋白及高血糖也能增加急性脑梗死患者 SAP 发生风险，临床应针对 SAP 危险因素采取相应措施，以降低 SAP 发生率。%Objective To analyze the risk factors of stroke - associated pneumonia( SAP) in patients with acute cerebral infraction. Methods From May 2013 to May 2015,a total of 1 244 inpatients with acute cerebral infraction were continuously selected in Department of Neurology and ICU,the Central Hospital of Wuhan,thereinto 286 patients complicated with SAP were served as case group,958 cases did not complicated with SAP were served as control group. Demographic characteristics,laboratory examination results and clinical features were compared between the two groups,and multivariate logistic regression analysis was used to analyze the influencing factors of SAP in patients with acute cerebral infraction. Results The incidence of SAP was 22. 99% (286 / 1 244) in patients with acute cerebral infraction. Univariate analysis showed that, there were statistically significant differences of proportion of age equal or over 70 years old,past medical history positive rate (including hypertension,coronary heart disease,atrial fibrillation and COPD),urine protein positive rate,incidence of non -lacunar infarction,dysphagia,disturbance of consciousness,subtentorial cerebral infraction,hemorrhagic transformation and stress ulcer,nasogastric support rate,fasting blood glucose and serum albumin level ( P ﹤ 0. 05 ). Multivariate logistic regression analysis showed that,age equal or over 70 years old〔 OR = 3. 650,95% CI(2. 236,5. 960)〕,with history of COPD〔OR = 18. 513,95% CI(9. 359,36. 623)〕,non - lacunar infarction〔 OR = 2. 453,95% CI(1. 507,3. 997)〕, dysphagia〔 OR = 2. 875,95% CI(1. 616,5. 114)〕,nasogastric support〔 OR = 19. 559,95% CI(9. 121,41. 942)〕, disturbance of consciousness〔OR = 3. 487,95% CI(1. 882,6. 463)〕,subtentorial cerebral infraction〔OR = 2. 011,95% CI (1. 090,3. 710)〕,hemorrhagic transformation〔OR = 3. 411,95% CI(1. 866,6. 237)〕 and stress ulcer〔 OR = 13. 658, 95% CI(5. 995,31. 326)〕were risk factors of SAP in patients with acute cerebral infraction(P ﹤ 0. 05). Conclusion Age equal or over 70 years old,with history of COPD,non - lacunar infarction,dysphagia,nasogastric support,disturbance of consciousness,subtentorial cerebral infraction,stress ulcer and hemorrhagic transformation are independent risk factors of SAP in patients with acute cerebral infraction,lower serum albumin level and hyperglycemia may increase the onset of SAP,too, relevant interventions should be take to reduce the incidence of SAP.