急性脑血管病合并院内获得性重症肺炎临床特征及危险因素研究  

Characteristics and Risk Factors of Severe Hospital Acquired Pneumonia Combined with Acute Cerebrovascular Diseases

作　　者：王本国[1] 杨楠[1] 曾静[1] 何宇峰[1] 汪峰[1] 彭慧渊[1] 张志强[1] 

机构地区：[1]广州中医药大学中山附属医院神经内科,广东省中山市528400

出　　处：《中国卒中杂志》2010年第11期894-898,共5页Chinese Journal of Stroke

摘　　要：目的探讨急性脑血管病合并院内获得性重症肺炎临床特征及相关危险因素。方法以院内感染且符合重症肺炎诊断标准的病例为研究对象(重症肺炎组,n=23),以同期院内获得性一般肺炎作为对照组(n=195),采用回顾性病例对照研究,分析其临床特征及相关危险因素。结果神经内科病区急性脑血管病合并院内获得性肺炎发生率为7.5%,重症肺炎发生率为0.8%,重症肺炎占肺炎比例为10.6%。与一般肺炎组相比,重症肺炎组伴有慢性阻塞性肺病和心功能不全的比率高(26.1%Vs 21.0%,P<0.05;34.8%Vs 19.O%,P<0.05),入院时美国国立卫生研究院卒中量表(national Institutes of health stroke scale,NIHSS)评分高(14.3±5.4 vs 6.7+3.2,P<0.05),意识障碍、吞咽障碍、双肺肺炎和低蛋白血症的发生率高(52.2%vs 1 6.4%,P<0.01;56.5%vs 25.1%,P<0.01;47.8%V8 23.6%,P<0.05;56.5%Vs 20.0%,P<0.01),镇静剂、抑酸剂使用率高(73.9%Vs 28.7%,P<0.01;91.3%Vs 35.9%,P<0.01),留置导尿管、鼻饲管、深静脉置管率高(82.6%vs28.7%,P<0.01;65.2%Vs 21%,P<0.01;73.9%vs 28.7%,P<0.01),C反应蛋白(C-reactive protein,CEP)水平较高(34.6±7.4 Vs 9.6±7.4 mg/L,P<0.05)。与一般肺炎组相比,重症肺炎组住院时间长且住院费用高(P均<0.01),出院时改良的Rankin量表评分高且死亡率高(P<0.05或<0.01)。结论重症医院获得性肺炎是急性脑血管病较严重的合并症,重症肺炎的发生与急性脑血管病的严重程度相关,具有多种危险因素,其病死率、致残率高,应提高认识。Objective To investigate and analyze the characteristics and risk factors of severe hospital acquires pneumonia （SHAP）. Methods A retrospective analysis was designed. The study group was the patients who were considered as severe hospital acquired pneumonia, the control group was the patients with common hospital acquired pneumonia （CHAP）. The characteristics and risk factors were analyzed and compared. Results The incidence of hospital acquired pneumonia （HAP） in neurology department was 7.5%, the incidence of SHAP was 0.8%, the ratio of SHAP to HAP was 10.6%. Compared with CHAP, SHAP group had a higher rate of COPD （26.1% to 21%, P〈0.05）, a higher rate of heart failure （34.8% to 19.0%, P〈0.05）, a higher NIHSS 04.33±5.4 to 6.7±3.2, P〈0.05）, a higher rate of alteration of consciousness （52.2% to 16.4%, P〈0.01）, a higher rate of swallowing disorder （56.5% to 25.1%, P〈0.01）, a higher rate of bilateral pneumonia （47.8% to 23.6%, P〈0.05） and a higher rate of hypoproteinemia （56.5% to 20.0%, P〈0.01）. The SHAP group had a more chances to administrate sedative therapy （73.9% to 28.7%, P〈0.01） and gastric acid-suppressive therapy （91.3% to 35.9%, P〈0.01）. The SHAP group had a higher utilization rate of urinary catheter intubation （82.6% to 28.7%, P〈0.01）, nasogastric tube feeding （65.2% to 21%, P〈0.01） and central venous catheter procedure （73.9% to 28.7%, P〈0.01）. The value of CRP of SHAP was higher（34.6±7.4 to 9.6±7.4 mg/L, P〈0.01）. The median hospital stay of SHAP was longer and the cost of hospitalization was higher. The mRS at discharge of SHAP and the mortality were both higher compared with HAP group. Conclusion Severe hospital acquired pneumonia is one of the most serious complications associated with acute cerebrovascular diseases in neurology department. SHAP is statistically associated with the severity of acute cerebrovascular diseases and has many risk factors with higher mortality and high levels of disability. Incre

关 键 词：卒中 肺炎 危险因素 

分 类 号：R743[医药卫生—神经病学与精神病学]