卒中相关性肺炎的发病原因及预后危险性因素的分析

目的 探讨卒中相关性肺炎（Stroke-Associated Pneumonia,SAP）原因、危险因素和病原菌.方法 回顾性分析2010年8月至2012年10月在我院治疗的258例脑卒中患者的病历资料,并分为SAP组和非SAP组,分析病原菌的分布,采用单因素分析和多因素Logistic回归分析SAP的相关危险因素.结果 258例脑卒中患者中,发生SAP患者116例,占45.0％,其中早发性肺炎72例（62.1％）;SAP的主要致病菌为金黄色葡萄球菌、革兰阴性菌、克雷伯氏杆菌属;单因素分析年龄、心脏基础病、糖尿病、吸烟史、意识状态、卒中性质、气管插管、气管切开、鼻饲治疗、预防性使用抗生素以及H2受体拮抗剂使用有关联,各组间比较差异有显著性（P＜0.05）;多因素分析结果显示患者年龄增加1岁,SAP发病率增加1.088倍;糖尿病患者SAP发生率是非糖尿病患者的1.776倍;意识障碍评分增加1分,SAP发生率下降0.897倍;鼻饲治疗的卒中患者发生肺炎的可能性是没有鼻饲治疗患者的5.461倍;预防性使用抗生素的患者发生SAP的几率是未使用者的2.811倍;使用H2受体拮抗剂的患者发生SAP的风险是没用患者的3.095倍.结论 患者年龄、糖尿病、意识障碍程度、鼻饲治疗、气管插管、气管切开、预防性抗生素的使用以及H2受体拮抗剂是脑卒中患者发生SAP的危险因素.

Reasons and risk factors for stroke associated pneumonia

Objective To explore the reasons, risk factors and the pathogeny of stroke associated pneumonia in the stroke patients. Methods Retrospectively analyzed the datas of 258 patients who suffered from stroke and got therapy in our hospital during August 2010 and October 2012, and the were divided into SAP group and non - SAP group. Analyzed the distribution of pathogeny and the risk factors. Results 116 patients in 258 suffered from SAP （45.0%）, where early - onset pneumonia accounted for 62. 1% ; The main pathogenic bacteria from sputum culture in SAP patients are staphylococcus, gram - negative bacterium and Clay bacillus genus. Single factor analysis demonstrated that factors like age, heart disease, diabetes, smoking history, conscious state, stroke nature, tracheal intubation, tracheal incision, nasal feeding, prophylactic antibiotic use and use of H2 - receptor blocking agents were associated with SAP. Multi - factorial analysis showed： SAP increase 1. 088 times for 1 - year age increase. Diabetic patients are more likely to got SAP than non - diabetic patients（ 1. 776 times）. Incidence of SAP decreases by 0. 897 times as Glasgow score increases one - point. Nasal feeding patients, patients taking prophylactic antibiotic and patients using H2 - receptor blocking agents are more likely to suffered from SAP （ OR values were 5. 461, 2. 811 and 3. 095 separately）. Conclusions Age, diabetes, consciousness state, nasal feeding treatment, tracheal intubation, tracheal incision, the application of prophylactic antibiotic and H2 - receptor blocking agents were risk factors for SAP.