老年脑卒中后吞咽障碍患者继发吸入性肺炎危险因素及预测模型的建立  

Establishment of a risk prediction model for secondary aspirationpneumonia in elderly stroke patients with dysphagia

作　　者：卢素娟[1] 林敏[1] 宋利 陈菲菲[1] 陈秀芳[1] LU Sujuan;LIN Min;SONG Li;CHEN Feifei;CHEN Xiufang(Department of Geriatrics,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang 325000,China)

机构地区：[1]温州医科大学附属第一医院老年医学科,浙江温州325000

出　　处：《中华全科医学》2025年第5期785-788,857,共5页Chinese Journal of General Practice

基　　金：浙江省医药卫生科技计划项目(2024KY1246)。

摘　　要：目的 分析脑卒中后吞咽障碍(PSD)患者继发吸入性肺炎(AP)的相关危险因素,并建立预测模型,以期为临床预防PSD患者AP的发生和干预提供科学依据。方法 回顾性收集2022年2月—2024年2月温州医科大学附属第一医院收治的82例老年PSD患者的临床资料,根据老年PSD患者是否继发AP分为AP组和Non-AP组,进行单因素、多因素logistic分析研究PSD继发AP的危险因素,并建立预测模型,通过受试者工作特征(ROC)曲线分析模型的预测效能。结果 82例PSD患者发生AP 31例,发生率为37.80%,纳入AP组,未发生AP的51例患者纳入Non-AP组。单因素分析结果显示,AP组和Non-AP组年龄、吸烟史、美国国立卫生研究院脑卒中量表(NIHSS)评分、洼田饮水试验、超敏C反应蛋白(hs-CRP)、降钙素原(PCT)、住院时间、管饲差异均有统计学意义(P<0.05)。多因素logistic回归分析显示,年龄、NIHSS评分、洼田饮水试验是PSD患者继发AP的独立影响因素(P<0.05)。ROC曲线分析显示该模型预测PSD患者发生AP的AUC为0.845(95%CI:0.659~0.953),以0.39为模型cut-off,其诊断PSD患者继发AP的灵敏度、特异度分别为88.89%、68.42%。结论 高龄、高NIHSS评分、高洼田饮水试验级别为PSD患者继发AP的独立危险因素,根据危险因素构建的预测模型对PSD患者继发AP有一定的预测价值。Objective To analyze the risk factors of secondary aspiration pneumonia(AP)in patients with post-stroke dysphagia(PSD)and to establish a prediction model,aiming to provide a scientific basis for clinical prevention and intervention strategies.Methods Clinical data of elderly patients with PSD admitted to the First Affiliated Hospital of Wenzhou Medical University from February 2022 to February 2024 were retrospectively collected.The elderly patients with PSD were divided into an AP group and a non-AP group according to the presence or absence of secondary AP.The risk factors of secondary AP in PSD were analyzed by univariate and multivariate logistic analyses,and a prediction model was subsequently established.The predictive efficiency of the model was evaluated by receiver operating characteristic(ROC)curve analysis.Results Among the 82 patients with PSD,31 developed AP,yielding an incidence rate of 37.80%.Univariate analysis showed statistically significant differences between the AP and non-AP group in age,smoking history,the National Institutes of Health stroke scale(NIHSS)score,Water swallow test results,high-sensitivity C-reactive protein(hs-CRP),procalcitonin(PCT),length of hospital stay,and tube feeding.Multivariate logistic regression analysis results identified age,NIHSS score,and water swallow test results as independent influence factors for secondary AP in patients with PSD(P<0.05).Based on the logistic analysis results,a prediction model was constructed.ROC curve analysis showed that the AUC of this model was 0.845(95%CI:0.659-0.953).At a cut-off value of 0.39,the model achieved a sensitivity of 88.89%and specificity of 68.42%.Conclusion Advanced age,elevated NIHSS score,and high drinking water test level were independent risk factors for secondary AP in PSD patients.The prediction model based on these risk factors demonstrates good discriminative ability for predicting secondary AP in PSD patients.

关 键 词：脑卒中 老年 吞咽障碍 吸入性肺炎 危险因素 预测模型 

分 类 号：R743[医药卫生—神经病学与精神病学] R563.1[医药卫生—临床医学]