康复期脑卒中患者卒中相关性肺炎的影响因素分析  

The risk factors for stroke-associated pneumonia

作　　者：招少枫[1] 窦祖林[2] 兰月[2] 何怀[1] 杨卫新[1] 李莉[1] 张涵君[1] 刘传道[1] 朱红军[1] 王维[1] 

机构地区：[1]苏州大学附属第一医院康复医学科,苏州215006 [2]中山大学附属第三医院康复医学科

出　　处：《中华物理医学与康复杂志》2013年第12期967-971,共5页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：国家自然科学基金（81071606）,国家自然科学基金青年基金（81101460）

摘　　要：目的通过对康复期缺血性脑卒中患者的回顾性研究，探讨卒中相关性肺炎（SAP）发生的影响因素。方法选取符合入选标准的缺血性脑卒中患者168例，根据患者住院4周内是否发生SAP分为SAP组（34例）和非SAP组（134例）。回顾性分析患者的一般资料（年龄、性别、糖尿病及房颤病史）、临床表现（意识水平、进食方式、构音障碍、肺炎）、日常生活活动（ADL）能力、洼田饮水试验评级、卒中分型及实验室检查（外周淋巴细胞计数）等，采用多因素Logistic回归分析相关影响因素。结果SAP组平均年龄[（73．5±10．0）岁]大于非SAP组[（67．8±10．4）岁]（P=0．006，P〈0．05）。其中，年龄≥75岁、鼻胃管进食、合并心房纤维性颤动或构音障碍、改良Barthel指数（MBI）〈40分、洼田饮水试验Ⅲ级和Ⅳ-ⅤV级、外周血淋巴细胞计数低的患者SAP发生率较高。多因素Logistic回归分析结果显示，外周血淋巴细胞计数与SAP的联系最为密切，是SAP的保护因素[OR=0．161，95％CI（0．059～0．438），P=0．000]，吞咽障碍[OR=5．471，95％CI（2．773～10．794），P=0．000]和房颤[OR=5．373，95％CI（1．470～19．639），P=0．011]是SAP的独立危险因素。结论房颤病史、吞咽障碍及外周血淋巴细胞计数是脑卒中患者康复期发生SAP的危险因素，加强对这些危险因素的重视与监控有助于改善脑卒中患者的预后。Objective The incidence and prognosis of stroke-associated pneumonia （SAP） among stroke patients during recovery stage have not been thoroughly investigated. We performed a retrospective evaluation to explore the risk factors of SAP. Methods One hundred and sixty-eight patients with ischemic stroke admitted to rehabilitation unit between January 2010 and July 2011 were divided into SAP group （34 cases） and non-SAP group （ 134 cases） according to whether SAP occured within 4 weeks of admission. The data on age, sex, level of consciousness, dysarthria, dysphagia, nasogastric feeding, pneumonia, diabetes, atrial fibrillation, modified Barthel index, ischemic stroke subtype, lymphocyte counts were retrospectively collected and used for a logistic regression analysis. Results The mean age （mean ± standard deviation） of SAP group was eider than non-SAP group （73.5 ±10.0 years vs. 67.8±10.4 years, P=0.006, P〈0.05）. It was shown that the incidence of SAP was associated with age ≥ 75 years, nasogastric feeding, dysarthria, modified Barthel index 〈 40, Kubota Toshio＇s drinking tests at Ⅲ or Ⅳ -Ⅴ levels and lower lymphocyte counts. In a multivariate analysis, lymphocyte counts showed the strongest association with SAP with a significant independent protect value （odds ration [ OR] 0. 161 95% confidence interval [CI] 0.059-0.438 P=0. 000）. Swallowing function （OR =5.471 95% CI 2. 773- 10. 794 P = 0. 000） and atrial fibrillation （ OR 5. 373 95% CI 1. 470-19. 639, P = 0.011 ） were significant independent risk factors of SAP. Conclusion Low lymphocyte counts, poor swallowing and atrial fibrillation were significant risk factors of SAP in stroke patients. Close monitoring of these factors can help prevent SAP and improve the prognosis of stroke patients at risk.

关 键 词：脑血管意外 肺炎 吞咽障碍 

分 类 号：R743.3[医药卫生—神经病学与精神病学]