急性脑出血并发相关性肺炎的临床特点及危险因素分析  

Analysis of clinical characteristics and risk factors of stroke-associated pneumonia in patients with acute cerebral hemorrhage

作　　者：李海燕[1] 戴缤[2] 沈光莉[1] 刘文宏[1] 付睿[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院神经内科,北京100038 [2]首都医科大学附属北京世纪坛医院神经外科,北京100038

出　　处：《中华老年医学杂志》2017年第3期274-277,共4页Chinese Journal of Geriatrics

基　　金：首都医科大学附属北京世纪坛医院院基金（2015-C11）

摘　　要：目的探讨急性脑出血并发相关性肺炎（SAP）的临床特点及相关危险因素。方法选取我院神经内科及神经外科2013年1月至2015年12月期间急性脑出血患者375例，按是否并发SAP分为观察组79例和对照组296例，收集患者临床资料，分析脑出血并发SAP的临床特点及相关危险因素。结果观察组38例感染革兰阴性菌，25例感染革兰氏阳性菌，混合感染16例。大量出血组sAP发生率高于非大量出血组（χ^2=11．301，P〈0．01）。脑干、脑室、小脑、丘脑出血以及多部位出血患者的SAP发生率均高于基底节出血和脑叶出血患者（χ^2=4．023，P〈0．05）。观察组平均住院时间为（32．7±16．2）d，较对照组（17．3±6．7）d延长（t=2．93，P〈0．01）。观察组的病死率（24．1％）高于对照组（3．7％）（χ^2=8．720，P〈0．01）。多因素Logistic回归分析显示，年龄≥65岁（OR=4．87）、肺部基础疾病史（OR=5．30）、吞咽困难（OR=7．38）、意识障碍（0R=4．11）、入院时NIHSS〉4分（OR=3．96）、侵袭性气道操作（OR=3．78）、鼻饲（OR=4．37）、使用H2受体阻滞剂（OR=2．09）是急性脑出血后并发SAP的独立危险因素。结论急性脑出血后SAP患者的病原菌以革兰阴性菌为主，住院时间延长，病死率升高。急性脑出血后SAP的发生与年龄≥65岁、肺部基础疾病史、吞咽困难、意识障碍、入院时NIHSS〉4分、侵袭性气道操作、鼻饲、使用H2受体阻滞剂等因素明显相关。Objective To explore the clinical characteristics and risk factors of stroke associated pneumonia （SAP） in patients with acute cerebral hemorrhage. Methods A total of 375 patients with acute cerebral hemorrhage were selected from the department of neurology and neurosurgery during January 2013 to December 2015 in our hospital. According to the incidence of SAP, they were divided into the observation group （complicated with SAP, n = 79） and control group （not complicated with SAP, n = 296）. Clinical data were collected, and clinical characteristics and related risk factors of SAP complicated with acute cerebral hemorrhage were analyzed. Results Among all the 79 SAP patients in observation group, there were 38 cases with gram-negative bacterial infections, 25 cases with gram positive bacterial infections, 16 cases with mixed infections. The SAP incidence in patients with massive hemorrhage was higher than that in patients with nonmasive hemorrhage （χ^2= 11.301, P〈0.01）, and was higher in patients with cerebellum, brainstem, ventricle, thalamus and muhifocal hemorrhage than that in patients with basal ganglion and brain lobe hemorrhage（χ^2=4. 023,P〈0.05）. The hospitalization days of the observation group was longer than that of the control group [（32.7 ± 16.2） versus （17.3 ±6.7）, t= 2.93, P〈 0. 01]. The mortality of the observation group was higher than that of the control group （24.1% versus 3.7%）, （χ^2=8.720,P〈0.01）. Multivariate Logistic regression analysis showed that age≥65 （OR= 4.87）, underlying lung diseases （OR = 5.30）, bulbar paralysis （OR = 7.39）, disorder of consciousness （OR= 4.11）, NIHSS score 〉 4 （OR = 3.96）, invasive airway operations （OR= 3.78）, gastric tube （OR = 4.37）, H2-receptor blocking agents application （OR= 2.09） were independent risk factors for SAP in acute intraerebral hemorrhage patients. Conclusions Gram negative bacteria are the main pathogens of SAP in patients with acute cerebral hemorrhage. The patie

关 键 词：脑出血 卒中相关性肺炎 危险因素 

分 类 号：R563.1[医药卫生—呼吸系统] R743.34[医药卫生—内科学]