急性脑梗死患者吞咽功能与肺部感染的关联性研究  

Relationship between swallowing function and pulmonary infection in patients with acute cerebral infarction

作　　者：郭燕[1] 周园园 谈莉莉 GUO Yan;ZHOU Yuanyuan;TAN Lili(Outpatient Department,Nanjing Brain Hospital,Nanjing 210029,China;Disinfection supply Center,Nanjing Brain Hospital,Nanjing 210029,China;Neurology Department,Nanjing Brain Hospital,Nanjing 210029,China)

机构地区：[1]南京脑科医院门诊,江苏南京210029 [2]南京脑科医院消毒供应中心,江苏南京210029 [3]南京脑科医院神经内科,江苏南京210029

出　　处：《现代医学》2025年第4期578-583,共6页Modern Medical Journal

摘　　要：目的:运用倾向性评分法(PSM)探讨急性脑梗死(ACI)患者吞咽功能与肺部感染的相关性。方法:选取2020年2月至2024年6月南京脑科医院收治的275例ACI患者,住院期间采用洼田饮水试验(WST)评价其吞咽功能。依据ACI患者是否并发肺部感染分成肺部感染组(n=69)和对照组(n=206),比较两组临床资料和吞咽功能的差异,多因素Logistic回归分析ACI并发肺部感染的影响因素。PSM按照1∶1最近邻居匹配法(K-近邻算法)对两组进行均衡匹配,并分析PSM匹配后的组间资料,比较不同吞咽障碍程度患者的肺部感染发生率。结果:肺部感染发生率25.09%(69/275)。PSM匹配前,肺部感染组年龄、入院NIHSS评分和合并糖尿病、大灶梗死、完全卧床、侵入性操作、吞咽障碍的比重均高于对照组(P<0.05),且上述均是肺部感染发生的独立影响因素(P<0.05)。PSM共匹配52对,均衡混杂协变量后,肺部感染组吞咽障碍发生率仍高于对照组[50.00%(26/52)vs.28.85%(15/52),P<0.05]。PSM匹配前后,WSTⅣ~Ⅴ级患者的肺部感染发生率均高于Ⅲ级患者,差异有统计学意义(P<0.05)。结论:吞咽障碍是ACI患者肺部感染发生的危险因素,且随吞咽障碍程度加重,肺部感染风险亦明显增加,为临床加强肺部感染风险管理提供重要依据。Objective:To investigate the correlation between swallowing function and pulmonary infection in patients with acute cerebral infarction(ACI)by using propensity score method(PSM).Methods:275 patients with ACI admitted to the Department of Neurology of Nanjing Brain Hospital from February 2020 to June 2024 were selected,and the swallowing function was evaluated by the Kota drinking water test(WST)during hospitalization.Patients with ACI were divided into pulmonary infection group and control group according to whether they were complicated with pulmonary infection.The difference of clinical data and swallowing function between the two groups was compared,and the influencing factors of ACI complicated with pulmonary infection were analyzed by multivariate Logistic regression.PSM matched the two groups evenly according to the 1∶1 nearest neighbor matching method(K-nearest neighbor algorithm),and analyzed the inter-group data after PSM matching to compare the incidence of pulmonary infection in patients with different degrees of dysphagia.Results:The incidence of pulmonary infection was 25.09%(69/275).Before PSM matching,the age,admission NIHSS score,proportion of combined diabetes mellitus,massive infarction,complete bed rest,invasive operation and dysphagia in the pulmonary infection group were higher than those in the control group(P<0.05),and these were all independent influencing factors for the occurrence of pulmonary infection(P<0.05).A total of 52 PSM pairs were matched,and after balancing mixed covariates,the incidence of dysphagia in the pulmonary infection group was still higher than that in the control group[50.00%(26/52)vs.28.85%(15/52),P<0.05].Before and after PSM matching,the incidence of pulmonary infection in WST gradeⅣ-Ⅴpatients was higher than that in gradeⅢpatients,and the difference was statistically significant(P<0.05).Conclusion:Dysphagia is a risk factor for pulmonary infection in ACI patients,and the risk of pulmonary infection increases significantly with the aggravation of dysphagia,

关 键 词：急性脑梗死 倾向性评分法 吞咽功能 肺部感染 相关性 

分 类 号：R743.33[医药卫生—神经病学与精神病学] R563.1[医药卫生—临床医学]