CAJ | 학술논문

目的通过对康复期缺血性脑卒中患者的回顾性研究,探讨卒中相关性肺炎(SAP)发生的影响因素.方法选取符合入选标准的缺血性脑卒中患者168例,根据患者住院4周内是否发生SAP分为SAP组(34例)和非SAP组(134例).回顾性分析患者的一般资料(年龄、性别、糖尿病及房颤病史)、临床表现(意识水平、进食方式、构音障碍、肺炎)、日常生活活动(ADL)能力、洼田饮水试验评级、卒中分型及实验室检查(外周淋巴细胞计数)等,采用多因素Logistic回归分析相关影响因素.结果 SAP组平均年龄[(73.5±10.0)岁]大于非SAP组[(67.8±10.4)岁](P=0.006,P＜0.05).其中,年龄≥75岁、鼻胃管进食、合并心房纤维性颤动或构音障碍、改良Barthel指数(MBI) ＜40分、洼田饮水试验Ⅲ级和Ⅳ～Ⅴ级、外周血淋巴细胞计数低的患者SAP发生率较高.多因素Logistic回归分析结果显示,外周血淋巴细胞计数与SAP的联系最为密切,是SAP的保护因素[OR=0.161,95％ CI(0.059～0.438),P=0.000],吞咽障碍[OR =5.471,95％ CI(2.773 ～ 10.794),P=0.000]和房颤[OR=5.373,95％ CI(1.470 ～ 19.639),P=0.011]是SAP的独立危险因素.结论房颤病史、吞咽障碍及外周血淋巴细胞计数是脑卒中患者康复期发生SAP的危险因素,加强对这些危险因素的重视与监控有助于改善脑卒中患者的预后.
목적 통과대강복기결혈성뇌졸중환자적회고성연구,탐토졸중상관성폐염(SAP)발생적영향인소.방법 선취부합입선표준적결혈성뇌졸중환자168례,근거환자주원4주내시부발생SAP분위SAP조(34례)화비SAP조(134례).회고성분석환자적일반자료(년령、성별、당뇨병급방전병사)、림상표현(의식수평、진식방식、구음장애、폐염)、일상생활활동(ADL)능력、와전음수시험평급、졸중분형급실험실검사(외주림파세포계수)등,채용다인소Logistic회귀분석상관영향인소.결과 SAP조평균년령[(73.5±10.0)세]대우비SAP조[(67.8±10.4)세](P=0.006,P＜0.05).기중,년령≥75세、비위관진식、합병심방섬유성전동혹구음장애、개량Barthel지수(MBI) ＜40분、와전음수시험Ⅲ급화Ⅳ～Ⅴ급、외주혈림파세포계수저적환자SAP발생솔교고.다인소Logistic회귀분석결과현시,외주혈림파세포계수여SAP적련계최위밀절,시SAP적보호인소[OR=0.161,95％ CI(0.059～0.438),P=0.000],탄인장애[OR =5.471,95％ CI(2.773 ～ 10.794),P=0.000]화방전[OR=5.373,95％ CI(1.470 ～ 19.639),P=0.011]시SAP적독립위험인소.결론 방전병사、탄인장애급외주혈림파세포계수시뇌졸중환자강복기발생SAP적위험인소,가강대저사위험인소적중시여감공유조우개선뇌졸중환자적예후.
Objective The incidence and prognosis of stroke-associated pneumonia (SAP) among stroke patients during recovery stage have not been thoroughly investigated.We performed a retrospective evaluation to explore the risk factors of SAP.Methods One hundred and sixty-eight patients with ischemic stroke admitted to rehabilitation unit between January 2010 and July 2011 were divided into SAP group (34 cases) and non-SAP group (134 cases) according to whether SAP occured within 4 weeks of admission.The data on age,sex,level of consciousness,dysarthria,dysphagia,nasogastric feeding,pneumonia,diabetes,atrial fibrillation,modified Barthel index,ischemic stroke subtype,lymphocyte counts were retrospectively collected and used for a logistic regression analysis.Results The mean age (mean ± standard deviation) of SAP group was elder than non-SAP group (73.5 ±10.0 years vs.67.8±10.4 years,P=0.006,P＜0.05).It was shown that the incidence of SAP was associated with age ≥ 75 years,nasogastric feeding,dysarthria,modified Barthel index ＜ 40,Kubota Toshio's drinking tests at Ⅲ or Ⅳ ～ Ⅴ levels and lower lymphocyte counts.In a multivariate analysis,lymphocyte counts showed the strongest association with SAP with a significant independent protect value (odds ration [OR] 0.16195％ confidence interval [CI] 0.059-0.438 P =0.000).Swallowing function (OR =5.471 95％ CI 2.773-10.794 P =0.000) and atrial fibrillation (OR 5.373 95 ％ CI 1.470-19.639,P =0.011) were significant independent risk factors of SAP.Conclusion Low lymphocyte counts,poor swallowing and atrial fibrillation were significant risk factors of SAP in stroke patients.Close monitoring of these factors can help prevent SAP and improve the prognosis of stroke patients at risk.