急性前循环大血管闭塞性脑梗死患者血管内治疗术后并发卒中相关性肺炎的危险因素分析  

Risk factors for stroke-associated pneumonia after endovascular therapyin patients with acute anterior circulation large vessel occlusion stroke

作　　者：李知衡 程娅雯 韩香凝 李嘉豪 马文龙 于嘉 罗国刚[1] 刘福德 LI Zhiheng;CHENG Yawen;HAN Xiangning;LI Jiahao;MA Wenlong;YU Jia;LUO Guogang;LIU Fude(Department of Neurology,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China)

机构地区：[1]西安交通大学第一附属医院神经内科,陕西西安710061

出　　处：《西安交通大学学报(医学版)》2025年第2期203-208,共6页Journal of Xi’an Jiaotong University(Medical Sciences)

基　　金：陕西省重点研发计划项目(No.2021SF-059);陕西省自然科学基础研究计划项目(No.2023-JC-QN-0893)。

摘　　要：目的 探讨急性前循环大血管闭塞性脑梗死患者血管内治疗(endovascular treatment, EVT)术后并发卒中相关性肺炎(stroke-associated pneumonia, SAP)的危险因素。方法 连续纳入2022年3月至2023年5月西安交通大学第一附属医院神经内科收治的115例急性前循环大血管闭塞性脑梗死并行EVT的患者,回顾性收集其临床资料,根据术后是否发生SAP将患者分为两组:SAP组(55例)和非SAP组(60例),比较两组患者的基线资料、手术及围手术期指标等,采用多因素Logistic回归分析明确上述患者发生SAP的独立危险因素。结果 单因素分析结果显示,SAP组患者入院时美国国立卫生研究院卒中量表(NIHSS)评分、吞咽功能障碍发生率、手术持续时间、静吸复合麻醉比例、术中取栓次数、术后即刻头颅CT高密度征发生率显著高于非SAP组,入院时格拉斯哥昏迷量表(GCS)评分、血管成功再通率显著低于非SAP组(P均<0.05)。将上述指标进行多因素Logistic回归分析示,手术持续时间长(OR=1.014,95%CI:1.001~1.028,P<0.05)、吞咽功能障碍(OR=6.137,95%CI:1.694~22.232,P<0.01)及血管未成功再通(OR=6.043,95%CI:1.062~34.382,P<0.05)是该类患者EVT术后发生SAP的独立危险因素。结论 手术持续时间长、吞咽功能障碍及血管未成功再通与急性前循环大血管闭塞性脑梗死患者EVT术后发生SAP直接相关,故临床诊治过程中应尽早对上述因素采取针对性措施,以降低此类患者术后SAP的发生率,进而改善其临床预后。Objective To investigate the risk factors for stroke-associated pneumonia(SAP)in patients with acute anterior circulation large-vessel occlusion stroke after endovascular treatment(EVT).Methods A total of 115 patients with acute anterior circulation large-vessel occlusion stroke who received EVT in the Department of Neurology,The First Affiliated Hospital of Xi’an Jiaotong University,from March 2022 to May 2023 were continuously included.Their clinical data were retrospectively collected.The patients were divided into SAP group(55 cases)and non-SAP group(60 cases)according to the occurrence of SAP after the operation.Differences in baseline data,surgical and perioperative indicators were compared between the two groups,and the risk factors for SAP after EVT were analyzed using the multivariate Logistic regression analysis.Results Univariate analysis showed there were significant differences in the Glasgow Coma Scale(GCS)score and the National Institute of Health Stroke Scale(NIHSS)score at admission,incidence of dysphagia,duration of the surgery,proportion of general anesthesia,rate of unsuccessful vascular recanalization and the rate of immediate CT high-density sign between SAP group and non-SAP group(all P<0.05).Multivariate Logistic regression analysis of the above indicators showed that duration of the surgery(OR=1.014,95%CI:1.001-1.028,P<0.05),dysphagia(OR=6.137,95%CI:1.694-22.232,P<0.01)and unsuccessful vascular recanalization(OR=6.043,95%CI:1.062-34.382,P<0.05)were independent risk factors for SAP after EVT.Conclusion Long duration of EVT,dysphagia and unsuccessful vascular recanalization are directly related to the occurrence of SAP after EVT in patients with acute anterior circulation large-vessel occlusive infarction.Therefore,targeted measures should be taken as soon as possible to reduce the incidence of SAP after EVT and thus improve the clinical prognosis of these patients.

关 键 词：前循环 大血管闭塞 血管内治疗 卒中相关性肺炎 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]