摘要
目的探讨卒中相关性肺炎(SAP)与缺血性脑卒中严重程度及预后的关系。方法选取2012年2月—2012年6月首都医科大学附属北京朝阳医院收治的94例缺血性脑卒中患者,根据SAP诊断标准分为SAP组(49例)和非SAP组(45例),收集患者一般资料(年龄、性别、高血压史、糖尿病史、高脂血症史、冠心病史、心房纤颤史、陈旧性脑梗死史、恶性肿瘤史、吸烟史),临床表现(局灶性神经缺损程度、有无意识障碍、有无吞咽障碍),神经影像学检查结果 (卒中面积、卒中部位),病情评估及预后评估结果〔住院时间、入院时美国国立卫生研究院卒中量表(NIHSS)评分、确诊SAP后NIHSS评分、入院时急性生理学与慢性健康状况评分(APACHEⅡ)、出院时改良的Rankin评分〕,实验室检查资料,病原学检查资料。分析SAP发生的相关因素,SAP与卒中严重程度(NIHSS评分)、健康状况(APACHEⅡ)、预后(改良Rankin评分)及住院时间的关系,SAP患者实验室检查各指标水平和病原学分布。结果 SAP组中年龄>75岁、意识障碍、吞咽困难、多发部位脑梗死、NIHSS评分>15分、APACHEⅡ>20分的发生率与非SAP组比较,差异均有统计学意义(P<0.05)。SAP组入院时NIHSS评分、入院时APACHEⅡ、出院时Rankin评分、住院时间及病死率与非SAP组比较,差异均有统计学意义(P<0.05);患者SAP前后NIHSS评分比较,差异亦有统计学意义(P<0.05)。SAP组入院时C反应蛋白、B型利钠肽、前清蛋白、清蛋白及红细胞沉降率水平与非SAP组比较,差异均有统计学意义(P<0.05)。病原学检查阳性者39例,阴性者10例,阳性率为80%。结果发现革兰阴性杆菌31株,其中鲍曼不动杆菌9株等;革兰阳性球菌9株,其中金黄色葡萄球菌8株等;真菌23株,其中白色念珠菌9株等。结论 SAP导致缺血性脑卒中患者临床症状加重,住院时间延长,预后不良及病死率增加。需要提高对SAP的认识及重视程度,并给予适当预防。
Objective To investigate the relationship between stroke -associated pneumonia （SAP） and the severity and prognosis of ischemic stroke. Methods 94 patients with ischemic stroke admitted to Beijing Chaoyang Hospital of Capital Medical University from February 2012 to June 2012 were divided into SAP group （49 cases） and non - SAP group （45 cases）. General clinical data （age, gender, histories of hypertension, diabetes, hyperlipidemia, coronary heart disease, atrial fibrillation, remote cerebral infarction, malignant tumor and smoking）, clinical manifestations （severity of focal nerve defect, disturbance of consciousness and dysphagia） , neuroimaging results （stroke area and location） , disease assessment and prognosis assessment （hospitality, NIHSS score on admission, NIHSS after confirming SAP, APACHE II score and Rankin score on discharge）, laboratory test results and etiological examination results. The related factors of SAP and the relationship between SAP and stroke severity （ NIHSS score）, health condition （ APACHE H ）, prognosis （ improved Rankin score） and hospitality, as well as the laboratory testing results and etiology distribution were all analyzed. Results Occurrence of age 〉 75 years, disturbance of consciousness, dysphagia, cerebral infarction in multiple parts, NIHSS 〉 15 and APACHE II 〉 20 between SAP group and control group showed statistically significant differences （ P 〈 0. 05 ）. The NIHSS score and Apache H score on admission, Rankin score on discharge, hospitality and mortality between SAP group and non - SAP group showed statistically significant differences （P 〈 0. 05 ）. The NIHSS on admission and NIHSS on discharge in SAP group also showed statistically significant difference （P 〈 0. 05）. The levels of C reactive protein, brain natriuretic peptide, prealbumin, albumin and erythrocyte sedimentation rate between SAP group and non - SAP group showed statistically significant differences （P 〈 0. 05 ）. Etiology exami- nation showed that 39 cases were positive and 10 cases were negative with a positive rate of 80%. The results showed 31 strains of gram negative bacilli （9 strains of Acinetobacter baumanii）, 9 strains of gram positive coccus （8 strains of staphylococcus aureus） and 23 strains of fungi （9 strains of Candida albicans）. Conclusion Conclusion SAP can aggravate the symptoms of ischemic stroke, extend hospitality, increase mortality and lead to poor prognosis. The understanding of SAP should be enhanced and appropriate prevention should be given to the patients.
出处
《中国全科医学》
CAS
CSCD
北大核心
2013年第11期1203-1205,共3页
Chinese General Practice
关键词
卒中
呼吸道感染
卒中相关性肺炎
疾病严重程度
预后
Stroke
Respiratory tract infection
Stroke -associated pneumonia
Severity of illness
Prognosis
