1 Department of Neurology, The St George Hospital, Kogarah, Australia.
2 Mental Health Program, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.
Int J Stroke. 2019 Feb;14(2):125-136. doi: 10.1177/1747493018806196. Epub 2018 Oct 22.
Post-stroke pneumonia and other infectious complications are serious conditions whose frequency varies widely across studies.
We conducted a systematic review to estimate the frequency of post-stroke pneumonia and other types of major infection.
MEDLINE, EMBASE, CINAHL, and PsycINFO databases were searched for prospective studies with consecutive recruitment of stroke patients. The primary outcome was post-stroke pneumonia. Secondary outcomes were any infection and urinary tract infection. Quality assessment was done using Newcastle Ottawa scale. Heterogeneity of estimates across study populations was calculated using Cochran's Q (heterogeneity χ) and I statistics. A total of 47 studies (139,432 patients) with 48 sample populations were eligible for inclusion. Mean age of patients was 68.3 years and their mean National Institute of Health Stroke Scale score was 8.2. The pooled frequency of post-stroke pneumonia was 12.3% (95% confidence interval [CI] 11%-13.6%; I = 98%). The pooled frequency from 2011 to 2017 was 13.5% (95% CI 11.8%-15.3%; I = 98%) and comparable with earlier periods (P interaction = 0.31). The pooled frequency in studies in stroke units was 8% (95% CI 7.1%-9%; I = 78%) and significantly lower than other locations (P interaction = 0.001). The pooled frequency of post-stroke infection was 21% (95% CI 13%-29.3%; I = 99%) and of post-stroke urinary tract infection was 7.9% (95% CI 6.7%-9.3%; I = 96%).
Approximately 1 in 10 stroke patients experience pneumonia during the acute period of hospital care. The frequency of post-stroke pneumonia has remained stable in recent decades but is lower in patients receiving stroke unit care compared to management in other ward settings.
中风后肺炎和其他感染性并发症是严重的病症，其在不同研究中的发生率差异很大。
我们进行了一项系统综述，以评估中风后肺炎和其他主要感染类型的发生率。
在 MEDLINE、EMBASE、CINAHL 和 PsycINFO 数据库中搜索了连续招募中风患者的前瞻性研究。主要结局是中风后肺炎。次要结局是任何感染和尿路感染。使用纽卡斯尔-渥太华量表进行质量评估。使用 Cochran's Q（异质性 χ）和 I 统计量计算研究人群之间估计值的异质性。共有 47 项研究（139432 名患者）和 48 个样本人群符合纳入标准。患者的平均年龄为 68.3 岁，平均 NIHSS 评分为 8.2。中风后肺炎的总发生率为 12.3%（95%置信区间 11%-13.6%；I=98%）。2011 年至 2017 年的总发生率为 13.5%（95%置信区间 11.8%-15.3%；I=98%），与早期阶段相当（P 交互=0.31）。在中风病房进行的研究中，中风后感染的总发生率为 8%（95%置信区间 7.1%-9%；I=78%），显著低于其他地点（P 交互=0.001）。中风后感染的总发生率为 21%（95%置信区间 13%-29.3%；I=99%），中风后尿路感染的总发生率为 7.9%（95%置信区间 6.7%-9.3%；I=96%）。
大约每 10 名中风患者中有 1 名在住院期间急性发作期间患有肺炎。尽管近几十年来中风后肺炎的发生率保持稳定，但与其他病房环境相比，在接受中风病房治疗的患者中，其发生率较低。
