老年急性脑梗死患者医院获得性肺炎的危险因素分析
Risk factors analysis of nosocomial pneumonia in elderly patients with acute cerebral infraction.
作者信息
NanZhu Yang, Xin Li, Xianghua Yun, Jun Chen, Min Li
机构信息
MD postgraduate of Neurology.
Department of Neurology, the Second Hospital of Tianjin Medical University.
出版信息
Medicine (Baltimore). 2019 Mar;98(13):e15045. doi: 10.1097/MD.0000000000015045.
To investigate the risk factors of nosocomial pneumonia (NP) in elderly patients with acute cerebral infarction (ACI).In this study, 324 aged 70 years and over patients with ACI who were admitted to the inpatient department of TianJin First Hospital (China) from January 2012 to February 2018 were retrospectively analyzed. The patients were divided into NP group (80 patients) and non-NP group (244 patients) according to whether NP was occurred 48 hours after hospitalization. Baseline profiles and biochemical analyses were compared between 2 groups. Information regarding risk factors for NP in elderly patients with ACI was collected from all patients. Associations with NP and outcome were evaluated.Among the total patients, NP occurred in 80 (24.69%) patients. There were no statistically significant differences between risk of NP and sex, current drinking, diabetes mellitus, stroke history, and levels of serum UA, TG, HDL-C, LDL-C, Glucose, chloride, potassium. Multivariate logistic regression analysis showed that the independent risk factors for NP were living alone (OR 4.723; CI 1.743∼12.802; P = .002), initial NIHSS score (OR 1.441; CI 1.191∼1.743; P = .000), NRS2002 score (OR 0.139; CI 0.087∼0.223; P = .000), BMI (OR 1.586; CI 1.353∼1.858; P = .000), a past pneumonia history (OR 0.073; CI 0.017∼0.321; P = .001), atrial fibrillation (AF) (OR 0.129; CI 0.033∼0.499; P = .003), CRP (OR 1.050; CI 1.017∼1.085; P = .003), BUN (OR 0.603; CI 0.448∼0.812; P = .001) and Cr (OR 1.036; CI 1.015∼1.057; P = .001). Level of albumin was an independent protective factor of NP in elderly patients with ACI (OR 0.865; CI 0.750∼0.999; P = .048). Furthermore, elderly patients with ACI who had NP had worse clinical outcomes both during hospitalization and after discharge (P < .05).We identified significant risk factors for NP in elderly patients with ACI, including living alone, initial NIHSS score, malnutrition, a past pneumonia history, AF, CRP, and Renal function were associated with NP in elderly patients with ACI. The clinical course was worse and the duration of hospital stay was longer in NP patients than in non-NP patients.
探讨老年急性脑梗死（ACI）患者医院获得性肺炎（NP）的危险因素。本研究回顾性分析了2012年1月至2018年2月期间在中国天津市第一医院住院的324例70岁及以上的ACI患者。根据患者住院48小时后是否发生NP，将其分为NP组（80例）和非NP组（244例）。比较两组患者的基线资料和生化分析结果。收集所有患者关于老年ACI患者NP危险因素的信息。评估与NP及预后的相关性。在所有患者中，80例（24.69%）发生了NP。NP发生风险与性别、当前饮酒情况、糖尿病、卒中史以及血清尿酸、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血糖、氯、钾水平之间无统计学显著差异。多因素logistic回归分析显示，NP的独立危险因素为独居（比值比[OR]4.723；可信区间[CI]1.743～12.802；P = 0.002）、初始美国国立卫生研究院卒中量表（NIHSS）评分（OR 1.441；CI 1.191～1.743；P = 0.000）、营养风险筛查2002（NRS2002）评分（OR 0.139；CI 0.087～0.223；P = 0.000）、体重指数（BMI）（OR 1.586；CI 1.353～1.858；P = 0.000）、既往肺炎病史（OR 0.073；CI 0.017～0.321；P = 0.001）、心房颤动（AF）（OR 0.129；CI 0.033～0.499；P = 0.003）、C反应蛋白（CRP）（OR 1.050；CI 1.017～1.085；P = 0.003）、血尿素氮（BUN）（OR 0.603；CI 0.448～0.812；P = 0.001）和肌酐（Cr）（OR 1.036；CI 1.015～1.057；P = 0.001）。白蛋白水平是老年ACI患者NP的独立保护因素（OR 0.865；CI 0.750～0.999；P = 0.048）。此外，发生NP的老年ACI患者在住院期间和出院后的临床结局均较差（P < 0.05）。我们确定了老年ACI患者NP的重要危险因素，包括独居、初始NIHSS评分、营养不良、既往肺炎病史、AF、CRP和肾功能，这些因素与老年ACI患者的NP相关。NP患者的临床病程比非NP患者更差，住院时间更长。
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