急性缺血性脑卒中患者需行有创通气治疗的肺炎：对短期和长期结局的影响。

Pneumonia in acute ischemic stroke patients requiring invasive ventilation: Impact on short and long-term outcomes.

机构信息

UMR 1137, IAME, Paris Diderot University, Sorbonne Paris Cité, 16 rue Henri Huchard, 75018 Paris, France; Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018 Paris, France.

UMR 1137, IAME, Paris Diderot University, Sorbonne Paris Cité, 16 rue Henri Huchard, 75018 Paris, France.

出版信息

J Infect. 2019 Sep;79(3):220-227. doi: 10.1016/j.jinf.2019.06.012. Epub 2019 Jun 22.

DOI:10.1016/j.jinf.2019.06.012

PMID:31238051

Abstract

OBJECTIVES

To describe the epidemiology and prognostic impact of pneumonia in acute ischemic stroke patients requiring invasive mechanical ventilation.

METHODS

Retrospective analysis from a prospective multicenter cohort study of critically ill patients with acute ischemic stroke requiring invasive mechanical ventilation at admission. Impact of pneumonia was investigated using Cox regression for 1-year mortality, and competing risk survival models for ICU mortality censored at 30-days.

RESULTS

We included 195 patients. Stroke was supratentorial in 62% and 64% of patients had a Glasgow coma scale score <8 on admission. Mortality at day-30 and 1 year were 56%, and 70%, respectively. Post-stroke pneumonia was identified in 78 (40%) patients, of which 46/78 (59%) episodes were present at ICU admission. Post-stroke pneumonia was associated with an increase in 1-year mortality (adjusted HR 1.49, 95%CI [1.01-2.20]). Post-stroke pneumonia was not associated with ICU mortality but was associated with a 1.6-fold increase in ICU length of stay (CSHR 0.62 [0.39-0.99], p = 0.06).

CONCLUSIONS

In ischemic stroke patients requiring invasive ventilation, pneumonia occurred in 40% of cases and was associated with a 49% increase in 1-year mortality. Post-stroke pneumonia did not impact day-30 mortality but increased ICU length of stay.

摘要

目的

描述需要进行有创机械通气的急性缺血性脑卒中患者肺炎的流行病学和预后影响。

方法

对需要有创机械通气的急性缺血性脑卒中重症患者进行前瞻性多中心队列研究的回顾性分析。使用 Cox 回归分析肺炎对 1 年死亡率的影响，并使用竞争风险生存模型对 ICU 死亡率进行 30 天截尾。

结果

共纳入 195 例患者。62%的脑卒中为幕上性，64%的患者入院时格拉斯哥昏迷评分<8。30 天和 1 年死亡率分别为 56%和 70%。78 例（40%）患者发生脑卒中后肺炎，其中 46/78（59%）例发生在 ICU 入院时。脑卒中后肺炎与 1 年死亡率增加相关（校正 HR 1.49，95%CI [1.01-2.20]）。脑卒中后肺炎与 ICU 死亡率无关，但与 ICU 住院时间延长 1.6 倍相关（CSHR 0.62 [0.39-0.99]，p=0.06）。