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急性缺血性脑卒中患者卒中后肺炎的危险因素及影响。

Risk factors for and impact of poststroke pneumonia in patients with acute ischemic stroke.

机构信息

Department of Neurology, Chongqing Medical University.

Department of Neurology, Chongqing School.

出版信息

Medicine (Baltimore). 2021 Mar 26;100(12):e25213. doi: 10.1097/MD.0000000000025213.

DOI:10.1097/MD.0000000000025213
PMID:33761707
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9282100/
Abstract

Poststroke pneumonia (PSP) is a common complication of stroke and an important cause of death following stroke. However, the treatment of PSP remains inadequate due to severe impairment to the respiratory system by PSP. Thus, it is crucial to focus on preventing PSP to improve the prognosis of patients with stroke.This prospective single-center Cohort study aimed to investigate the risk factors for pulmonary infection following an ischemic stroke and identify whether PSP significantly influences the prognosis of patients after stroke.Altogether, 451 patients who were treated for acute ischemic stroke in the First Affiliated Hospital of Chongqing Medical University in China between April 2017 and April 2018 were enrolled. Clinical data from the patients from admission to 3 months after discharge were collected. PSP was the primary outcome and poor prognosis or death at 3 months following discharge was the secondary outcome observed in this study. We performed logistic regression analyses to identify the risk factors for PSP and test an association between pneumonia and poor prognosis or death after stroke.Our findings revealed the following risk factors for PSP: atrial fibrillation odds ratio (OR) = 2.884, 95% confidence intervals (CI) = 1.316-6.322), being bedridden (OR = 2.797, 95%CI = 1.322-5.921), subject to an invasive procedure (OR = 12.838, 95%CI = 6.296-26.178), massive cerebral infarction (OR = 3.994, 95%CI = 1.496-10.666), and dysphagia (OR = 2.441, 95%CI = 1.114-5.351). Pneumonia was a risk factor for poor prognosis (OR = 2.967, 95%CI = 1.273-6.915) and death (OR = 5.493, 95%CI = 1.825-16.53) after stroke.Hence, since pneumonia increases the risk of poor prognosis and death following acute ischemic stroke, preventing, and managing the risk factors for PSP may improve the prognosis and reduce the mortality after stroke.

摘要

卒中后肺炎(PSP)是中风的常见并发症,也是中风后死亡的重要原因。然而,由于 PSP 严重损害了呼吸系统,PSP 的治疗仍然不足。因此,关注 PSP 的预防对于改善中风患者的预后至关重要。

本前瞻性单中心队列研究旨在探讨缺血性中风后肺部感染的危险因素,并确定 PSP 是否显著影响中风后患者的预后。

共有 451 名在中国重庆医科大学第一附属医院接受急性缺血性中风治疗的患者被纳入本研究。收集了患者从入院到出院后 3 个月的临床数据。PSP 是主要结局,出院后 3 个月预后不良或死亡是本研究的次要结局。我们进行了逻辑回归分析,以确定 PSP 的危险因素,并测试肺炎与中风后预后不良或死亡之间的关联。

我们的研究结果揭示了 PSP 的以下危险因素:心房颤动比值比(OR)=2.884,95%置信区间(CI)=1.316-6.322),卧床(OR=2.797,95%CI=1.322-5.921),接受有创性操作(OR=12.838,95%CI=6.296-26.178),大面积脑梗死(OR=3.994,95%CI=1.496-10.666)和吞咽困难(OR=2.441,95%CI=1.114-5.351)。肺炎是预后不良(OR=2.967,95%CI=1.273-6.915)和死亡(OR=5.493,95%CI=1.825-16.53)的危险因素。

因此,由于肺炎增加了急性缺血性中风后预后不良和死亡的风险,预防和管理 PSP 的危险因素可能会改善中风后的预后并降低死亡率。

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