伴有吞咽障碍的急性卒中患者发生肺炎的早期危险因素：前瞻性病例系列研究  

Eady risk factors for pneunmnia in acute stroke patients with dysphagia： a prospective case series study

作　　者：张新颜[1] 闫福岭[1] 何逸康[2] 

机构地区：[1]东南大学附属中大医院神经内科,南京210009 [2]东南大学附属中大医院康复科,南京210009

出　　处：《国际脑血管病杂志》2012年第6期408-412,共5页International Journal of Cerebrovascular Diseases

基　　金：卫生部科研基金（LW201007）

摘　　要：目的探讨伴有吞咽障碍的急性卒中患者并发卒中相关性肺炎（stroke—associated pneumonia，SAP）的早期危险因素。方法应用改良曼恩吞咽能力评估量表（Modified Mann Assessment of Swallowing Ability，MMASA）对发病后24h内入院的急性卒中患者进行吞咽障碍筛查，以筛查出的吞咽障碍患者作为研究对象。根据发病1周内是否发生SAP，将患者分为SAP组和非SAP组。采用单变量和多变量logistic回归分析对人口学资料、既往病史、临床资料和实验室资料进行分析，确定吞咽障碍患者发生SAP的早期危险因素，并对独立危险因素进行受试者工作特征曲线（receiver operatilag characteristic，ROC）分析，以评估其对SAP的预测价值。结果113例急性卒中患者中，55例存在吞咽障碍，其中30例（54．54％）发生SAP。单变量分析显示，SAP组（n=30）美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分[中位数（四分位间距）：16分（13～21分）对3分（1～7分）；P=0．000]、中性粒细胞计数[（8．22±3．75）×10^9／L对（5．39±2．56）×10^9／L；t=3．198，P=0．002）]、出血性卒中比例（96．00％对4．00％；X^2=7．333，P=0．007）和机械通气比例（20．00％对0．00％；X^2=5．612，P=0．018）显著高于非SAP组（n=25），而MMASA评分[中位数（四分位间距）：53分（27～84分）对88分（66—92分）；P=0．002]、格拉斯哥昏迷量表（Glasgow Coma Score，GCS）评分[中位数（四分位间距）：10分（7～13分）对15分（11～15分）；P=0．001]、淋巴细胞计数[（1．17±0．54）×10^2／L对（1．75±0．81）×10^9／L；t=-3．563，P=0．001]、CD3^＋T淋巴细胞计数[（0．73±0．42）×10^9／L对（1．14±0．85）×10^9／L；t=-2．307，P=0．025）、CD^＋T淋巴细胞计数[（0．38±0．22）×10^9／L对（0．69±0．57）×10^9／L；t=-2．761，P=0．008）显著低于非SAP�Objective To investigate the early risk factors for stroke-associated pneumonia （SAP） in acute stroke patients with dysphagia. Methods The modified Mann assessment of swallowing ability （MMASA） was used to screen dysphagia in patients with acute stroke admitted to hospital within 24 hours after symptom onset. The patients with dysphagia were used as research subjects. They were divided into either a SAP goup or a non-SAP group according to whether they had SAP or not within one week of symptom onset. Univariate and multivariate logistic regression analyses were used to analyze the data of demogaphy, past history, clinical practice, and laboratory. The early risk factors for the occurrence of SAP in patients with dysphagia were identified. The independent risk factors were analyzed with receiver operating characteristic （ROC） curves in order to assess their predictive value for SAP. Results Of the 113 patients with acute stroke, 55 had dysphagia, and 30 of them （54. 54% ） had SAP. Univariate analysis showed that the National Institutes of Health Stroke Scale （NIHSS） score （median, [ interquartile range] 16, [13 -21 ] vs. 3, [ 1 -7 ] ; P = 0. 000）, nentrophil counts （[ 8.22 ± 3.75 ] × 10^9/L vs. [ 5. 39 ± 2. 56] × 10^9/L; t = 3. 198; P = 0. 002）, proportion of hemorrhagic stroke （96. 00% vs. 4. 00% ; X^2 = 7. 333; P = 0. 007）, and proportion of mechanical ventilation （20.00% vs. 0.00%; X^2 = 5.612; P= 0.018） in the SAP group （n= 30） were sigantly higher than those in the non-SAp group （n =25）, while the MMASA score （median, E interquartile range] 53, [ 27 - 84 ] vs. 88, [ 66 - 92 ] ; P = 0. 002）, Glasgow Coma sCale （GCS） score （median, [ interquartile range] 10, [7 - 13] vs. 15, [ 11 - 15] ; P =0. 001）, lymphocyte counts （[ 1. 17 ±0. 54] × 10^9/L vs. [ 1.75 ± 0. 81 ] 10^9/L; t = - 3. 563, P = 0. 001）, CD3 ^＋ T lymphocyte counts （[0.73 ± 0. 42] × 10^9/L vs. [ 1. 14 ~ 0.85] × 10^9/L; t= -2.307; P= 0.025）, and CD4^＋T lymphocyte counts （[0

关 键 词：吞咽障碍 卒中 肺炎 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]