高侧卧位通气对GCS评分≤8分急性脑出血患者卒中相关性肺炎发生风险的影响  

Effect of high lateral recumbent ventilation on the risk of stroke associated pneumonia in patients with acute cerebral hemorrhage with GCS score≤8 points

作　　者：许春阳 杨璨宇 赵珂 王运良 苗旺[4] 王永乐 王志愿 李文[1] XU Chunyang;YANG Canyu;ZHAO Ke;WANG Yunliang;MIAO Wang;WANG Yongle;WANG Zhiyuan;LI Wen(The First Affiliated Hospital of Pingdingshan University,Pingdingshan 467000,China;The First Clinical Medical College of Zhengzhou University,Zhengzhou 450053,China;No.148 Hospital of Zibo,Zibo 255300,China;The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450053,China)

机构地区：[1]平顶山学院第一附属医院,河南平顶山467000 [2]郑州大学第一临床医学院,河南郑州450053 [3]淄博一四八医院,山东淄博255300 [4]郑州大学第一附属医院,河南郑州450053

出　　处：《中国实用神经疾病杂志》2024年第11期1400-1405,共6页Chinese Journal of Practical Nervous Diseases

基　　金：河南省高等学校重点科研项目(编号:23A320022)。

摘　　要：目的探讨急性脑出血后卒中相关性肺炎(SAP)的独立危险因素,分析早期高侧卧位通气对GCS评分≤8分患者发生SAP的影响。方法收集2018-07—2023-06于平顶山学院第一附属医院神经外科、重症医学科及神经重症住院的急性脑出血患者的临床资料,依据患者发病后7 d内是否出现卒中相关性肺炎分为感染组和非感染组,评估患者的慢性病史,包括高血压、糖尿病、慢性肺病史及目前吸烟状况。记录所有入组患者的临床特征、入院时GCS评分、入院后是否行高侧卧位通气,7 d内是否发生卒中相关性肺炎,记录相关实验室数据(入院时随机血糖、肌酐、尿素氮、尿酸及白细胞、中性粒细胞百分比、淋巴细胞百分比、淋巴细胞计数及血清白蛋白等)。结果共入组710例符合标准的急性脑出血患者,其中258例(36.3%)出现SAP。与对照组相比,SAP组患者的GCS评分相对较低[5.0(3.0,7.0)比14.0(10.0,15.0),P<0.05)]。SAP组患者入院时随机血糖、白细胞计数、中性粒细胞百分比均显著高于对照组(均P<0.05),而淋巴细胞计数明显低于非SAP组[1.07(0.70,1.70)比1.47(1.04,2.00),P<0.05]。二元Logistic回归的多变量分析显示GCS评分、入院时随机血糖、尿素氮、淋巴细胞绝对值及手术治疗均是SAP的独立危险因素。根据筛选出的危险因素,进行ROC曲线分析表明:GCS评分预测SAP的曲线下面积(AUC)为0.859(95%CI:0.830~0.888,P<0.001),最佳截断值:8分,灵敏度:0.81,特异度:0.81。对GCS评分≤8分患者依据患者是否进行高侧卧位通气进行分组,发现高侧卧位通气组患者发生SAP风险明显下降(62.1%比77.3%,P<0.05)。结论急性脑出血患者出现SAP的危险因素是多方面的,GCS评分、入院时随机血糖、尿素氮、淋巴细胞绝对值及手术治疗均是SAP的独立危险因素。GCS评分对急性脑出血后SAP发生具有早期的预测价值,同时早期行高侧卧位通气可降低GCS评分≤8分患者SAP�Objective To investigate the independent risk factors for stroke associated pneumonia(SAP)after acute cerebral hemorrhage(ACH)and analyze the effect of early high lateral recumbent ventilation on the occurrence of SAP in patients with GCS score≤8 points.Methods The acute cerebral hemorrhage patients hospitalized in the Department of Neurosurgery,Department of the Intensive Care Unit and Department of Neurocritical Care in the First Affiliated Hospital of Pingdingshan University from July 2018 to June 2023 were collected.According to whether they had suffered from SAP within 7 days after onset,the patients were divided into the infection group and the non-infection group.The chronic medical history of the patients,including hypertension,diabetes,chronic lung disease history and current smoking status were evaluated.The clinical characteristics of all enrolled patients were recorded,including GCS score at admission,whether high lateral recumbent ventilation was performed after admission,and whether SAP occurred within 7 days.This study also recorded relevant laboratory data,including random blood glucose,creatinine,urea nitrogen,uric acid and white blood cell count(WBC),neutrophil percentage,lymphocyte percentage,lymphocyte count,serum albumin at admission.Results A total of 710 patients with acute cerebral hemorrhage who met the criteria were enrolled,of which 258(36.3%)patients had SAP.Patients in the SAP group had lower GCS scores[5.0(3.0,7.0)vs 14.0(10.0,15.0),P<0.05)].The random blood glucose,WBC,and percentage of neutrophils at admission in the SAP group were significantly higher than those in the control group(P<0.05),while the lymphocyte count was significantly lower than that in the non SAP group[1.07(0.70,1.70)vs 1.47(1.04,2.00),P<0.05].The multivariate analysis of binary Logistic regression showed that GCS score,random blood glucose at admission,urea nitrogen,the absolute count of lymphocytes,and surgical treatment were all independent risk factors for SAP.According to the selected risk factors,ROC cur

关 键 词：急性脑出血 卒中相关性肺炎 高侧卧位通气 危险因素 GCS评分 

分 类 号：R743.34[医药卫生—神经病学与精神病学]