急性脑血管病并发肺部感染预后的影响因素
摘要
目的探讨急性脑血管病并发肺部感染预后的影响因素。方法急性脑血管病并发肺部感染患者434例,根据出院时格拉斯哥昏迷评分(GCS)进行分组,GCS>8分纳入预后良好组,GCS≤8分纳入预后不良组,收集一般资料和疾病资料。结果 434例急性脑血管病并发肺部感染患者中预后不良者107例(24.65%),预后良好者327例(75.34%),Logistic回归分析显示,年龄<60岁(OR=0.527,95%CI为0.293～0.950)、无糖尿病(OR=0.528,95%CI为0.281～0.988)、住院时间≤14 d(OR=0.358,95%CI为0.162～0.788)、无吞咽功能障碍(OR=0.324,95%CI为0.183～0.576)、无侵入性操作(OR=0.449,95%CI为0.241～0.836)是急性脑血管病并发肺部感染预后良好的保护因素(P<0.05)。结论急性脑血管病并发肺部感染患者受多种因素影响,高龄、糖尿病、住院时间长、吞咽功能障碍、侵入性操作是影响急性脑血管病并发肺部感染预后良好的危险因素。
引文
1 Naghavi M,Wang H,Lozano R,et al.Global,regional,and national age-sex specific all-cause and cause-specific mortality for 240 causes of death,1990-2013:a systematic analysis for the Global Burden of Disease Study 2013[M].Springer:Third International Conference on System Science in Health Care,2015:957-79.
2 丁素菊,吴雄枫.脑卒中诊断治疗指南的缺陷——点评《中国急性缺血性脑卒中诊治指南2014》[J].医学与哲学,2016;37(12):13-6.
3 钱庆芳.注射用丹参多酚酸治疗合并肺部感染的急性轻中度脑梗塞临床疗效观察[D].长春:吉林大学,2017.
4 Jamal A,Sankhyan N,Jayashree M,et al.Full outline of unresponsiveness score and the Glasgow Coma Scale in prediction of pediatric coma[J].World J Emerg Med,2017;8(1):55-7.
5 Goliszek S,Wisniewska M,Kurnicka K,et al.Patent foramen ovale increases the risk of acute ischemic stroke in patients with acute pulmonary embolism leading to right ventricular dysfunction[J].Thromb Res,2014;134(5):1052-6.
6 胡亚梅,李书剑,李刚,等.重症脑血管病患者肺部感染病死率的影响因素分析[J].中华医院感染学杂志,2014;24(13):3243-4.
7 Sykora M,Siarnik P,Diedler J,et al.I2-blockers,pneumonia,and outcome after ischemic stroke:evidence from virtual international stroke trials archive[J].Stroke,2015;46(5):1269-74.
8 孙茂军,陈琳迪,寇雪莲,等.老年急性脑卒中患者肺部感染危险因素与预防[J].中华医院感染学杂志,2016;26(7):1517-9.
9 袁祖琴,沈朝阳,张红金,等.脑卒中患者肺部感染危险因素分析与预防[J].中华医院感染学杂志,2016;26(19):4434-6.
10 任贞,王志强,王彦阔,等.急性脑卒中患者肺部感染的预后及影响因素研究[J].中华医院感染学杂志,2017;27(1):92-4.
11 王欣华,孟琛琛,刘霞,等.吞咽功能评估表联合康复锻炼对脑卒中吞咽障碍患者肺部感染的影响[J].中华医院感染学杂志,2017;27(21):4869-72.
12 沈萍,翟盼盼,刘畅,等.重症脑卒中患者呼吸机肺炎发生相关因素分析[J].中华医院感染学杂志,2018;28(3):340-3.
13 But A,Yetkin M A,Kanyilmaz D,et al.Analysis of epidemiology and risk factors for mortality in ventilator-associated pneumonia attacks in intensive care unit patients[J].Turkish J Med Sci,2017;47(3):812-6.
14 Galal YS,Youssef MRL,Ibrahiem SK.Ventilator-associated pneumonia:incidence,risk factors and outcome in paediatric intensive care units at cairo university hospital[J].J Clin Diagn Res,2016;10(6):43-7.
15 Antoni SL.A study of ventilator-associated pneumonia risk factors and outcomes[J].J Assoc Physicians India,2016;64(1):118-20.
16 Costa DK,Yang JJ,Manojlovich M.The critical care nurse work environment,physician staffing,and risk for ventilator-associated pneumonia[J].Am J Infect Control,2016;44(10):1181-3.
2 丁素菊,吴雄枫.脑卒中诊断治疗指南的缺陷——点评《中国急性缺血性脑卒中诊治指南2014》[J].医学与哲学,2016;37(12):13-6.
3 钱庆芳.注射用丹参多酚酸治疗合并肺部感染的急性轻中度脑梗塞临床疗效观察[D].长春:吉林大学,2017.
4 Jamal A,Sankhyan N,Jayashree M,et al.Full outline of unresponsiveness score and the Glasgow Coma Scale in prediction of pediatric coma[J].World J Emerg Med,2017;8(1):55-7.
5 Goliszek S,Wisniewska M,Kurnicka K,et al.Patent foramen ovale increases the risk of acute ischemic stroke in patients with acute pulmonary embolism leading to right ventricular dysfunction[J].Thromb Res,2014;134(5):1052-6.
6 胡亚梅,李书剑,李刚,等.重症脑血管病患者肺部感染病死率的影响因素分析[J].中华医院感染学杂志,2014;24(13):3243-4.
7 Sykora M,Siarnik P,Diedler J,et al.I2-blockers,pneumonia,and outcome after ischemic stroke:evidence from virtual international stroke trials archive[J].Stroke,2015;46(5):1269-74.
8 孙茂军,陈琳迪,寇雪莲,等.老年急性脑卒中患者肺部感染危险因素与预防[J].中华医院感染学杂志,2016;26(7):1517-9.
9 袁祖琴,沈朝阳,张红金,等.脑卒中患者肺部感染危险因素分析与预防[J].中华医院感染学杂志,2016;26(19):4434-6.
10 任贞,王志强,王彦阔,等.急性脑卒中患者肺部感染的预后及影响因素研究[J].中华医院感染学杂志,2017;27(1):92-4.
11 王欣华,孟琛琛,刘霞,等.吞咽功能评估表联合康复锻炼对脑卒中吞咽障碍患者肺部感染的影响[J].中华医院感染学杂志,2017;27(21):4869-72.
12 沈萍,翟盼盼,刘畅,等.重症脑卒中患者呼吸机肺炎发生相关因素分析[J].中华医院感染学杂志,2018;28(3):340-3.
13 But A,Yetkin M A,Kanyilmaz D,et al.Analysis of epidemiology and risk factors for mortality in ventilator-associated pneumonia attacks in intensive care unit patients[J].Turkish J Med Sci,2017;47(3):812-6.
14 Galal YS,Youssef MRL,Ibrahiem SK.Ventilator-associated pneumonia:incidence,risk factors and outcome in paediatric intensive care units at cairo university hospital[J].J Clin Diagn Res,2016;10(6):43-7.
15 Antoni SL.A study of ventilator-associated pneumonia risk factors and outcomes[J].J Assoc Physicians India,2016;64(1):118-20.
16 Costa DK,Yang JJ,Manojlovich M.The critical care nurse work environment,physician staffing,and risk for ventilator-associated pneumonia[J].Am J Infect Control,2016;44(10):1181-3.