血管内治疗的急性缺血性脑卒中患者合并肺部感染的相关危险因素分析

目的观察接受血管内治疗的急性缺血性脑卒中患者合并肺部感染的相关危险因素。方法回顾性分析2016年1月~2018年6月南宁市第二人民医院神经内科接受血管内治疗的急性缺血性脑卒中患者124例,根据是否并发肺部感染分为感染组48例,非感染组76例。分析2组一般情况和可能影响发生肺部感染的相关因素。疾病的严重程度采用美国国立卫生研究院卒中量表(NIHSS)评分和格拉斯哥昏迷评分(GCS)。采用logistic回归分析急性缺血性脑卒中患者发生肺部感染的独立危险因素。结果感染组年龄≥70岁、术前NIHSS评分>15分、术前GCS≤8分、糖尿病、慢性肺病、后循环病变、机械取栓和抽吸、全身麻醉、术后持续镇静>1 d、气管插管>1 d及呼吸机辅助通气>1d比例明显高于非感染组,局麻加深度镇静比例明显低于非感染组,差异有统计学意义(P<0.05,P<0.01)。多因素logistic回归显示,术前NIHSS评分>15分(OR=2.558,95%CI:1.741~2.563,P=0.003)、术前GCS≤8分(OR=4.358,95%CI:1.568~5.374,P=0.001)、后循环病变(OR=3.589,95%CI:0.328~3.251,P=0.005)、全身麻醉(OR=1.025,95%CI:1.159~2.664,P=0.041)和术后持续镇静>1 d(OR=3.254,95%CI:2.682~3.267,P=0.028)是血管内治疗的急性缺血性脑卒中并发肺部感染的独立危险因素。结论病情严重程度、病变部位、意识障碍和慢性肺病是导致急性期血管内介入患者合并肺部感染的危险因素。

Risk factors for acute ischemic stroke with pulmonary infection after intravascular intervention

Objective To study the risk factors for acute ischemic stroke(AIS)with pulmonary infection after intravascular intervention.Methods One hundred and twenty-four AIS patients who underwent intravascular intervention in our hospital from January 2016 to June 2018 were divided into pulmonary infection group(n=48)and pulmonary infection-free group(n=76).The general clinical data and risk factors for AIS with pulmonary infection were analyzed between the two groups.The severity of AIS was scored according to the NIHSS and GCS respectively.The independent risk factors for AIS with pulmonary infection were analyzed by multivariate logistic regression analysis.Results The rate of age≥70 years,preoperative NIHSS score>15,preoperative GCS score≤8,mechanical thrombtomy and aspiration,general anesthesia,postoperative continuous sedation>1 d,endotracheal intubation>1 d,respirator-assisted ventilation>1 d,and the incidence of diabetes,chronic lung disease,posterior circulation lesions were significantly higher while the rate of local anesthesia plus deep sedation was significantly lower in pulmonary infection group than in pulmonary infection-free group(P<0.05,P<0.01).Multivariate logistic regression analysis showed that preoperative NIHSS score>15,preoperative GCS score≤8,posterior circulation lesion,general anesthesia and postoperative continuous sedation>1 d were the independent risk factors for AIS with pulmonary infection after intravascular intervention(OR=2.558,95%CI:1.741-2.563,P=0.003;OR=4.358,95%CI:1.568-5.374,P=0.001;OR=3.589,95%CI:0.328-3.251,P=0.005;OR=1.025,95%CI:1.159-2.664,P=0.041;OR=3.254,95%CI:2.682-3.267,P=0.028).Conclusion Severity and site of AIS,consciousness disorder and chronic lung disease are the independent risk factors for AIS with pulmonary infection after intravascular intervention.