中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2014年
6期
684-687
,共4页
缺血性卒中%A2DS2评分工具%卒中相关性肺炎%吞咽功能%NIHSS评分%缺血性卒中部位%非发酵菌%危险分层
缺血性卒中%A2DS2評分工具%卒中相關性肺炎%吞嚥功能%NIHSS評分%缺血性卒中部位%非髮酵菌%危險分層
결혈성졸중%A2DS2평분공구%졸중상관성폐염%탄인공능%NIHSS평분%결혈성졸중부위%비발효균%위험분층
Ischemic stroke%A2DS2 scoring tool%Stroke associated pneumonia%Function of deglutition%NIHSS scoring%Location of ischemic stroke%Non-fermenters bacteria%Risk stratification
目的:对缺血性卒中患者用A2DS2评分工具对卒中相关性肺炎(SAP)进行风险评估。方法回顾性分析2009年至2011年武汉市市中心医院神经内科收治的缺血性卒中患者1279例并进行 A2DS2评分,A2DS2评分工具:年龄(Age)≥75岁为1分,心房颤动(atrial fibrillation)为1分,吞咽困难(dysphagia)为2分,男性(male sex)为1分;卒中严重程度(stroke severity):NIHSS评分0~4分为0分,5~15分为3分,≥16分为5分。根据A2DS2评分分为3组:0分组620例,1~9分组383例,≥10分组276例,将三组进行对照分析。SAP诊断标准为:卒中发生后胸部影像学检测发现新出现或进展性肺部浸润性病变,同时合并2个以上临床感染症状:(1)发热≥38℃;(2)新出现的咳嗽,咳痰或原有呼吸道疾病症状加重,伴或不伴胸痛;(3)肺实变体征,和(或)湿音,(4)外周血白细胞≥10×109 L-1或≤4×109 L-1,伴或不伴核左移,同时排除某些与肺炎临床表现相近的疾病如:肺结核、肺部肿瘤、非感染性肺间质病、肺水肿、肺栓塞、肺不张等病。三组患者分别进行SAP发生率、病死率以及与缺血性卒中部位的相关性分析,计量资料呈正态分布的用均数±标准差(x ±s),采用t检验,计数资料用百分比表示,采用χ2检验。结果 A2 DS2评分≥10分组其卒中相关性肺炎的发生率明显高于1~9分及0分组(71.7%vs.22.7%,71.7%vs.3.7%),≥10分组其病死率明显高于1~9分及0分组(16.7%vs.4.96%,16.7%vs.0.3%),SAP组后循环脑梗死及跨MCA、ACA分布区梗死发生率较非SAP组的患者明显增高(35.1%vs.10.1%)(11.4%vs.7.5%),差异具有统计学意义,≥10分组非发酵菌感染率明显增高。结论 A2 DS2评分为卒中相关性肺炎提供了一个危险分层依据,对于A2DS2评分≥10分的急性缺血性卒中患者需要加强措施预防SAP发生。
目的:對缺血性卒中患者用A2DS2評分工具對卒中相關性肺炎(SAP)進行風險評估。方法迴顧性分析2009年至2011年武漢市市中心醫院神經內科收治的缺血性卒中患者1279例併進行 A2DS2評分,A2DS2評分工具:年齡(Age)≥75歲為1分,心房顫動(atrial fibrillation)為1分,吞嚥睏難(dysphagia)為2分,男性(male sex)為1分;卒中嚴重程度(stroke severity):NIHSS評分0~4分為0分,5~15分為3分,≥16分為5分。根據A2DS2評分分為3組:0分組620例,1~9分組383例,≥10分組276例,將三組進行對照分析。SAP診斷標準為:卒中髮生後胸部影像學檢測髮現新齣現或進展性肺部浸潤性病變,同時閤併2箇以上臨床感染癥狀:(1)髮熱≥38℃;(2)新齣現的咳嗽,咳痰或原有呼吸道疾病癥狀加重,伴或不伴胸痛;(3)肺實變體徵,和(或)濕音,(4)外週血白細胞≥10×109 L-1或≤4×109 L-1,伴或不伴覈左移,同時排除某些與肺炎臨床錶現相近的疾病如:肺結覈、肺部腫瘤、非感染性肺間質病、肺水腫、肺栓塞、肺不張等病。三組患者分彆進行SAP髮生率、病死率以及與缺血性卒中部位的相關性分析,計量資料呈正態分佈的用均數±標準差(x ±s),採用t檢驗,計數資料用百分比錶示,採用χ2檢驗。結果 A2 DS2評分≥10分組其卒中相關性肺炎的髮生率明顯高于1~9分及0分組(71.7%vs.22.7%,71.7%vs.3.7%),≥10分組其病死率明顯高于1~9分及0分組(16.7%vs.4.96%,16.7%vs.0.3%),SAP組後循環腦梗死及跨MCA、ACA分佈區梗死髮生率較非SAP組的患者明顯增高(35.1%vs.10.1%)(11.4%vs.7.5%),差異具有統計學意義,≥10分組非髮酵菌感染率明顯增高。結論 A2 DS2評分為卒中相關性肺炎提供瞭一箇危險分層依據,對于A2DS2評分≥10分的急性缺血性卒中患者需要加彊措施預防SAP髮生。
목적:대결혈성졸중환자용A2DS2평분공구대졸중상관성폐염(SAP)진행풍험평고。방법회고성분석2009년지2011년무한시시중심의원신경내과수치적결혈성졸중환자1279례병진행 A2DS2평분,A2DS2평분공구:년령(Age)≥75세위1분,심방전동(atrial fibrillation)위1분,탄인곤난(dysphagia)위2분,남성(male sex)위1분;졸중엄중정도(stroke severity):NIHSS평분0~4분위0분,5~15분위3분,≥16분위5분。근거A2DS2평분분위3조:0분조620례,1~9분조383례,≥10분조276례,장삼조진행대조분석。SAP진단표준위:졸중발생후흉부영상학검측발현신출현혹진전성폐부침윤성병변,동시합병2개이상림상감염증상:(1)발열≥38℃;(2)신출현적해수,해담혹원유호흡도질병증상가중,반혹불반흉통;(3)폐실변체정,화(혹)습음,(4)외주혈백세포≥10×109 L-1혹≤4×109 L-1,반혹불반핵좌이,동시배제모사여폐염림상표현상근적질병여:폐결핵、폐부종류、비감염성폐간질병、폐수종、폐전새、폐불장등병。삼조환자분별진행SAP발생솔、병사솔이급여결혈성졸중부위적상관성분석,계량자료정정태분포적용균수±표준차(x ±s),채용t검험,계수자료용백분비표시,채용χ2검험。결과 A2 DS2평분≥10분조기졸중상관성폐염적발생솔명현고우1~9분급0분조(71.7%vs.22.7%,71.7%vs.3.7%),≥10분조기병사솔명현고우1~9분급0분조(16.7%vs.4.96%,16.7%vs.0.3%),SAP조후순배뇌경사급과MCA、ACA분포구경사발생솔교비SAP조적환자명현증고(35.1%vs.10.1%)(11.4%vs.7.5%),차이구유통계학의의,≥10분조비발효균감염솔명현증고。결론 A2 DS2평분위졸중상관성폐염제공료일개위험분층의거,대우A2DS2평분≥10분적급성결혈성졸중환자수요가강조시예방SAP발생。
Objective To assess the risk assessment of stroke associated pneumonia (SAP ) in patients with ischemic stroke using A2DS2 score.Methods A total of 1279 patients with ischemic stroke who were admitted and treated in our department from 2009 to 201 1 were retrospectively analyzed and applicated A2DS2 score.A2DS2 score was calculated as follows:Age ≥75 years=1,atrial fibrillation=1, dysphagia=2,male sex=1;stroke severity:NIHSS score 0-4=0,5-15 =3,≥16=5.The patients were divided into three groups according to A2DS2 score:620 in score 0 group,383 in score 1-9 group,276 in score ≥10 group.The three groups were comparatively analyzed.The diagnostic criteria for SAP were as follows:newly emerging lesions or progressively infiltrating lesions in post-stroke chest images combined with more than two of the following clinical symptoms of infection:(1 )fever ≥38 ℃;(2 )newly occurred cough,productive cough or exacerbation of preexisting respiratory tract symptoms with or without chest pain;(3)signs of pulmonary consolidation and/or moist rales;(4)peripheral white blood cell count≥10 ×109 L -1 or≤4 ×109 L-1 with or without nuclear shift to left,while excluding some diseases with similar clinical manifestations to pneumonia, such as tuberculosis, pulmonary tumors, non-infectious interstitial lung disease,pulmonary edema,pulmonary embolism and atelectasis.Analysis of the incidence and mortality of SAP as well as the correlation with ischemic stroke site were performed in the three groups,respectively. Mean ± standard deviation (x ±s)was used to represent measurement data with normal distribution and t test was used.Percentage was used to represent enumeration data and χ2 test was used.Results The incidence of SAP was significantly higher in A2DS2 score ≥10 group compared with those in score 1-9 and score 0 groups (7 1.7%vs..22.7%,7 1.7%vs..3.7%,respectively),whereas the mortality in score ≥10 group was significantly higher than those in score 1-9 and score 0 groups (16.7%vs.4.96%,16.7%vs.0.3%,respectively).The incidences of cerebral infarction in posterior circulation and cross-MCA, ACA distribution areas were significantly higher in SAP group compared with those in non-SAP group (35.1%vs.10.1%,11.4%vs.7.5%,respectively).The incidence of non-fermentative bacteria infection was significantly increased in score ≥10 group.Conclusions A2DS2 score provides a basis for risk stratification of SAP.The prevention of SAP needs to be strengthened in acute ischemic stroke patients having a A2DS2 score ≥10.