Department of Emergency Medicine, Changshu Hospital Affiliated to Soochow University, the First People's Hospital of Changshu, Changshu, Jiangsu Province, China.
Eur Rev Med Pharmacol Sci. 2021 Jan;25(2):856-865. doi: 10.26355/eurrev_202101_24654.
OBJECTIVE: The incidence of SAP (stroke-associated pneumonia) is high in integrated ICU (Intensive Care Unit), and it might result in sepsis, which exacerbates the clinical outcome and increases mortality. It is necessary to investigate the epidemiological features of post-stroke infection and sepsis, identify the risk factors and analyze the prognosis. PATIENTS AND METHODS: We retrospectively analyzed the data of 329 patients with cerebral infarction or cerebral hemorrhage, from seven tertiary university hospitals in Suzhou, Jiangsu Province, between January 1, 2016, and December 31, 2016. Basic demographic and clinical data including common health evaluation, stroke severity, microbiological parameters, surgical interventions and treatments were recorded for the analysis. SAP was diagnosed according to the criteria and recommendation from American Heart Association (AHA). RESULTS: 188 (66.4%) patients suffered pneumonia, 124 patients were diagnosed as SAP. Compared with SAP, patients with non-SAP pulmonary infection had prolonged mechanical ventilation time, prolonged central venous catheter indwelling time, and higher incidence of sepsis (17.7% vs. 48.4%). 53 patients (18.7%) developed sepsis during hospitalization, whose mortality rate during hospitalization and the occurrence of neurologic dysfunction at 3 months were significantly increased (p<0.05). 130 positive results of sputum cultures were found. The detected pathogens were mainly gram-negative bacteria. The pathogenic detection rate of non-SAP patients with pulmonary infection was higher (78.1%). The in-hospital mortality was 16.3% and the related risk factors were higher NIHSS score at admission, lower GCS score at admission, pulmonary infection (especially non-SAP pulmonary infection) and sepsis during hospitalization. CONCLUSIONS: The incidence of pulmonary infection after stroke in the integrated ICU is high, and it is easy to be complicated with sepsis, prolonging the mechanical ventilation time, central venous catheter indwelling time and hospitalization time, and the prognosis of long-term neurological function is relatively poor. The definition of stroke-associated pneumonia has implications for the classification of clinical infections, the prediction of possible pathogenic pathogens, and the guidance of anti-infective treatment.
目的：综合重症监护病房（ICU）中 SAP（卒中相关性肺炎）的发病率较高，可能导致脓毒症，从而加重临床预后并增加死亡率。因此，有必要研究卒中后感染和脓毒症的流行病学特征，确定危险因素并分析预后。
方法：我们回顾性分析了 2016 年 1 月 1 日至 12 月 31 日期间，来自江苏省苏州市 7 所三级大学医院的 329 例脑梗死或脑出血患者的数据。记录了基本人口统计学和临床数据，包括常见健康评估、卒中严重程度、微生物学参数、手术干预和治疗。SAP 根据美国心脏协会（AHA）的标准和建议进行诊断。
结果：188 例（66.4%）患者发生肺炎，124 例患者被诊断为 SAP。与 SAP 相比，非 SAP 肺部感染患者的机械通气时间延长、中心静脉导管留置时间延长，且脓毒症发生率更高（17.7%比 48.4%）。住院期间 53 例（18.7%）患者发生脓毒症，其住院期间死亡率和 3 个月时神经功能障碍的发生率显著升高（p<0.05）。痰培养阳性结果 130 例，检出病原体主要为革兰阴性菌。非 SAP 肺部感染患者的病原学检测率较高（78.1%）。住院死亡率为 16.3%，相关危险因素为入院时 NIHSS 评分较高、入院时 GCS 评分较低、肺部感染（尤其是非 SAP 肺部感染）和住院期间脓毒症。
结论：综合 ICU 中卒中后肺部感染的发病率较高，易并发脓毒症，延长机械通气时间、中心静脉导管留置时间和住院时间，长期神经功能预后较差。卒中相关性肺炎的定义对临床感染的分类、可能病原体的预测以及抗感染治疗的指导具有重要意义。
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