脑卒中相关性肺炎的危险因素

目的 探讨急性脑卒中患者卒中相关性肺炎(SAP)的发生率、危险因素及病原学特点。方法 回顾性分析642例急性脑卒中患者病历资料，并分为SAP组和非SAP组，用单因素分析和多因素logistic回归分析SAP的相关危险因素，统计SAP患者的病原菌分布特点。结果 642例急性脑卒中患者SAP的发生率为13.2%，其中71.8%为早发性肺炎;脑梗死、脑出血、蛛网膜下腔出血患者SAP发生率分别为10.9%、19.4%、29.4%(P均<0.01)；前循环、后循环、前+后循环脑卒中的SAP发生率分别为8.3%、22.3%、24.6%(P均<0.01)；SAP患者的死亡率为31.7%。年龄≥65岁、糖尿病、吸烟史、吞咽障碍、低蛋白血症、预防性应用抗生素、脱水剂、H2受体阻滞剂或质子泵抑制剂、鼻饲治疗为SAP的危险因素。其中，有吸烟史及鼻饲治疗的患者，早发性肺炎的发生率较高(P<0.01)。有低蛋白血症及预防性应用抗生素治疗的患者，晚发性肺炎的发生率更高(P<0.01)。培养出菌株65例，革兰阴性菌67.7%，主要是肺炎克雷伯杆菌；革兰阳性菌26.2%，主要是金黄色葡萄球菌；真菌6.2%，主要是白色假丝酵母菌。结论 SAP多发生在入院72h内，以革兰阴性菌为主要致病菌；SAP增加患者死亡率；不同卒中类型和部位的SAP发生率不同；早发性肺炎和晚发性肺炎的危险因素不同。

Risk factors for stroke-associated pneumonia

Objective To investigate the incidence,risk factors and the pathogeny of stroke-associated pneumonia(SAP) in acute stroke patients.Methods Clinical data of 642 patients with acute stroke,divided into SAP and non-SAP,were retrospectively analyzed.Univariate analysis and multivariate logistic regression analysis were used to investigate related risk factors for SAP.Pathogens of SAP were analyzed.Results The incidence of SAP in 642 patients with acute stroke was 13.2%,in which early-onset pneumonia(EOP) accounted for 71.8%.Incidences of SAP in the cerebral infarct group,cerebral hemorrhage group and subarachnoid hemorrhage group were 10.9%,19.4% and 29.4%,respectively(P<0.01).Incidences of SAP in the anterior circulation group,posterior circulation group and anterior-posterior circulation group were 8.3%,22.3% and 24.6,respectively(P<0.01).The mortality of SAP was 31.7%.The risk factors of SAP were age≥65,diabetes,smoking,dysphagia,hypoproteinemia,antibiotic prophylaxis,dehydrant,H2-blocker or inhibitors of proton pumps,and nasal feeding.Patients with smoking and nasal feeding had an increased risk for EOP(P<0.01);those with hypoproteinemia and antibiotic prophylaxis had an increased risk for late-onset pneumonia(LOP)(P<0.01).65 strains of microorgnisms were obtained by sputum culture.Percentages of the Gram-negative bacteria,Gram-positive ones,and fungi were 67.7%,26.2% and 6.2%,respectively.The major strain was K.pneumoniae in Gram-negative bacteria,Enterococcus in Gram-positive bacteria,and Candida albicans in fungi.Conclusions SAP mostly occurs in the first 72 hours of admission,whose major strains are Gram-negative bacteria.The mortality of SAP is quite high in acute stroke.The incidence of SAP is varied in different types and locations.Risk factors are different between EOP and LOP.