A2DS2评分在预测急性缺血性脑卒中相关性肺炎中的应用

目的 研究急诊病房急性缺血性脑卒中患者卒中相关性肺炎（SAP）的发生率及危险因素，并探讨A2DS2评分对SAP的预测效能。方法 2014年4月至2017年3月连续纳入271例急性缺血性脑卒中患者，将其分为SAP组（n=103）与非SAP组（n=168），分析SAP的危险因素，并应用受试者工作特征(ROC)曲线分析评价A2DS2评分对SAP的预测作用。 结果 急诊病房中SAP发生率为38.0%，两组年龄、吞咽障碍、美国国立卫生研究院卒中量表评分（NIHSS）、合并症（心房颤动、冠心病和脑卒中）、意识障碍（格拉斯哥昏迷评分<9分）差异均有统计学意义（P<0.05）；Logistic 回归分析显示年龄>75岁、吞咽障碍、高NIHSS评分和意识障碍是SAP发生的危险因素；ROC曲线分析结果显示, A2DS2评分预测SAP的曲线下面积(AUC)为0.928。结论 A2DS2评分能有效预测急诊病房急性缺血性脑卒中患者SAP的发生。

Application of A2DS2 score for predicting stroke associated pneumonia in patients with acute ischemic stroke

Objective To explore the incedence of stroke associated pneumonia (SAP) and assess the value of A2DS2 score in predicting SAP in patients with ischemic stroke in emergency ward. Methods Baseline characteristics and laboratory data of 271 patients with ischemic stroke in emergency ward from April 1, 2014 to March 31, 2017 were analysed. Patients were allocated into SAP group (n=103) and non SAP group (n=168). The multivariable logistic regression was applied to investigate risk factors for the progression of SAP. Receiver operating characteristic curve (ROC) was used to evaluate the predictive effect of A2DS2 score for ischemic stroke associated pneumonia. Results Totally, 103 (38.0%) patients developed SAP. There were significant differences between the two groups in terms of age, dysphagia, National Institute of Health stroke scale scores (NIHSS), comorbidities (atrial fibrillation, ecoronary heart disease and history of stroke) and conscious disturbance (Glasgow coma score <9) all of which were of statistical difference. The multivariable logistic regression analysis revealed that age over 75 years old, dysphagia, higher NIHSS and conscious disturbance were the risk factors for the development of SAP. The area under the ROC curve (AUC) of A2DS2 score for predicting stroke associated pneumonia was 0.928. Conclusion A2DS2 score provides an effective method for prediction of the risk of ischemic stroke associated pneumonia.