目的 分析缺血性脑卒中患者院内合并肺部感染的影响因素.方法 回顾性分析 2020 年 3 月至 2022 年 2 月期间在南通市第三人民医院治疗的 214 例缺血性脑卒中患者病历资料.根据《中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南》分组,未合并肺部感染患者作为对照组(n=104),合并肺部感染患者作为观察组(n=110).对患者性别、年龄、发病至入院时间、合并基础疾病、鼻饲饮食、美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分、格拉斯哥昏迷量表(Glasgow Coma Scale,GCS)评分、气管插管、呼吸机辅助通气等临床资料进行调查,分析缺血性脑卒中患者合并肺部感染的危险因素.结果 观察组男 56 例,女 54 例,年龄(73.59±8.21)岁;对照组男 45 例,女 59 例,年龄(65.32±5.62)岁.单因素分析结果显示,观察组患者年龄、鼻饲饮食、NIHSS评分、GCS评分、是否气管插管、是否呼吸机辅助通气与对照组比较差异有统计学意义(t=8.511、χ2=11.622、t=5.721、t=4.282、χ2=6.868、χ2=6.145,P均<0.05).多因素Lo-gistic回归分析结果显示,鼻饲饮食(OR=5.447,95%CI:2.477～11.976)、NIHSS评分(OR=8.339,95%CI:2.598～26.768)、GCS评分(OR=7.660,95%CI:3.369～17.413)、气管插管(OR=6.184,95%CI:2.447～15.628)、呼吸机辅助通气(OR=4.302,95%CI:1.830～10.110)是缺血性脑卒中患者合并肺部感染的独立危险因素.结论 鼻饲饮食、病情严重程度、意识障碍、气管插管及呼吸机辅助通气是导致缺血性脑卒中患者发生肺部感染的独立危险因素,因此在患者入院时应及时评估,有针对性地实施预防措施.
Risk factors for nosocomial pulmonary infection in patients with ischemic stroke
Objective To explore the factors influencing the nosocomial pulmonary infection in patients with ischemic stroke.Methods The clinical data of 214 patients with ischemic stroke treated in the Third People's Hospital of Nantong from March 2020 to February 2022 were retrospectively analyzed.According to the Guidelines for Diagnosis and Treatment of Adult Hospital-acquired Pneumonia and Ventilator-related Pneumonia in China,the patients without lung infection were assigned to control group(n=104),and the patients with lung infection were enrolled in observation group(n=110).Clinical data such as gender,age,time from onset to admission,underlying diseases,nasogastric feeding,National Institute of Health Stroke Scale(NIHSS)score,Glasgow Coma Scale(GCS)score,endotracheal intubation,and ventilator-assisted ventilation were investigated.The risk factors for nosocomial pulmonary infection in patients with ischemic stroke were analyzed.Results There were 56 males and 54 females in the observation group,with a mean age of(73.59±8.21)years.There were 45 males and 59 females in the control group,with a mean age of(65.32±5.62)years.Univariate analysis showed significant differences in the age,nasogastric feeding,NIHSS score,GCS score,endotracheal intubation,and ventilator-assisted ventilation between the two groups(t=8.511,χ2=11.622,t=5.721,t=4.282,χ2=6.868,χ2=6.145,all P<0.05).Multivariate Logistic regression analysis result showed that nasogastric feeding(OR=5.447,95%CI:2.477-11.976),NIHSS score(OR=8.339,95%CI:2.598-26.768),GCS score(OR=7.660,95%CI:3.369-17.413),endotracheal intubation(OR=6.184,95%CI:2.447-15.628),and ventilator-assisted ventilation(OR=4.302,95%CI:1.830-10.110)were independent risk factors for pulmonary infection in patients with ischemic stroke.Conclusion The nasogastric feeding,severity of illness,impairment of consciousness,endotracheal intubation and ventilator-assisted ventilation are independent risk factors for pulmonary infection in patients with ischemic stroke.Therefore,the patients should be evaluated in time and taken targeted preventive measures on admission.
Ischemic strokeComplicated pulmonary infectionNational Institute of Health Stroke ScaleGlasgow Coma ScaleEndotracheal intubationVentilator-assisted ventilation
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