Netsu Shizuka, Mizuma Atsushi, Sakamoto Masaki, Yutani Sachiko, Nagata Eiichiro, Takizawa Shunya
Department of Neurology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
Department of Nursing Department, Tokai University Hospital, Isehara, Japan.
Dysphagia. 2018 Oct;33(5):716-724. doi: 10.1007/s00455-018-9897-4. Epub 2018 Apr 21.
Stroke-associated pneumonia (SAP) is a frequent complication in acute ischemic stroke (IS) patients, especially those receiving tube feeding (TF). In this retrospective study, we investigated whether or not cilostazol, a pluripotent phosphodiesterase III-specific inhibitor with anti-platelet and vasculogenic effects, can prevent SAP in these patients and reduce their duration of stay in intensive care unit/hospitalization. We recruited 158 IS patients receiving TF. Patients' characteristics (including age, gender, past history), National Institute of Health Stroke Scale and serum albumin level on admission, concomitant medications associated with SAP prevention (including cilostazol), and stroke characteristics (bilateral subcortical white matter lesion, brainstem involvement, large infarction, and asymptomatic hemorrhagic infarction) were compared between the SAP(-) and SAP(+) groups. Cilostazol was more frequently used in the SAP(-) group (20.8% vs. 6.1%, p < 0.05). Duration of intensive care unit was longer in patients with SAP (9 ± 8 vs. 6 ± 6 days, p < 0.05). However, the length of stay in an intensive care unit and duration of hospitalization were not reduced due to the prevention of SAP by cilostazol treatment. Cilostazol administration was associated with reduced SAP incidence in acute IS patients receiving TF.
卒中相关性肺炎（SAP）是急性缺血性卒中（IS）患者常见的并发症，尤其是接受管饲（TF）的患者。在这项回顾性研究中，我们调查了西洛他唑（一种具有抗血小板和血管生成作用的多能磷酸二酯酶III特异性抑制剂）是否能预防这些患者发生SAP并缩短其在重症监护病房的住院时间/住院时长。我们招募了158例接受TF的IS患者。比较了SAP（-）组和SAP（+）组患者的特征（包括年龄、性别、既往史）、入院时的美国国立卫生研究院卒中量表评分和血清白蛋白水平、与预防SAP相关的合并用药（包括西洛他唑）以及卒中特征（双侧皮质下白质病变、脑干受累、大面积梗死和无症状出血性梗死）。西洛他唑在SAP（-）组的使用频率更高（20.8%对6.1%，p<0.05）。SAP患者的重症监护病房住院时间更长（9±8天对6±6天，p<0.05）。然而，西洛他唑治疗预防SAP并未缩短患者在重症监护病房的住院时间和住院时长。在接受TF的急性IS患者中，使用西洛他唑与降低SAP发生率相关。
