A~2DS~2评分用于卒中相关性肺炎风险因素分析及其相关护理策略
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摘要
目的探讨引起高龄患者卒中相关性肺炎(SAP)的风险因素以验证A~2DS~2评分,并针对其相关风险因素采取相应的护理策略。方法回顾性分析2015年1月至2016年1月入住我院神经内科重症监护室超过24 h的215名老年卒中患者的临床资料,采取单因素和多因素Logistic回归分析法筛选SAP的发病危险因素,采用ROC曲线评价A~2DS~2评分在SAP发生中的诊断效率。结果 215例卒中患者中,SAP发病44例(20.47%)。单因素分析显示,年龄、高血压、糖尿病、吸烟史、低蛋白血症、房颤、吞咽困难及NIHSS评分均与SAP发病具有相关性(P<0.05)。多因素Logistic分析显示,吸烟、NIHSS评分、房颤和吞咽困难为SAP发病的独立预测因素(P<0.05)。其中A~2DS~2评分≤3分患者SAP发病率仅为2.27%,而≥8分患者SAP发病率则达到54.55%。ROC曲线分析显示,A~2DS~2评分为5分时,其在老年SAP诊断中的正确指数最高。结论 A~2DS~2评分是简便、安全、有效的SAP风险评估方法,可以广泛应用到临床应用中。
Objective To investigate the risk factors of elderly patients with stroke-associated pneumonia(SAP) to verify the A~2DS~2 score, and to take corresponding nursing strategies for related risk factors. Methods The clinical data of 215 elderly stroke patients admitted to neurology intensive care unit of our hospital for more than 24 hours from January 2015 to January 2016 were retrospectively analyzed. The univariate and multivariate Logistic regression analysis were used to screen possible risk factors for SAP, and ROC curve was used to evaluatethe efficiency of A~2DS~2 score in the diagnosis of SAP.Results There were 44(20.47%) patients with SAP in 215 stroke patients. The univariate analysis showed that age,hypertension, diabetes, smoking history, hypoproteinemia, atrial fibrillation, dysphagia and NIHSS score were all correlated with SAP(P <0.05). The multivariate Logistic analysis showed that smoking history, NIHSS score, atrial fibrillation and dysphagia were the independent predictors of SAP(P<0.05). The incidence of SAP in patients with A~2DS~2 score of≤3 was only 2.27%, while the incidence of SAP in patients whose A~2DS~2 score≥8 was 54.55%. The ROC curve analysis showed that when A~2DS~2 score was 5, it had the highest correct index in the diagnosis of SAP in the elderly. Conclusion A~2DS~2 score is a simple, safe and effective SAP risk assessment method, which can be widely used in clinical application.
Objective To investigate the risk factors of elderly patients with stroke-associated pneumonia(SAP) to verify the A~2DS~2 score, and to take corresponding nursing strategies for related risk factors. Methods The clinical data of 215 elderly stroke patients admitted to neurology intensive care unit of our hospital for more than 24 hours from January 2015 to January 2016 were retrospectively analyzed. The univariate and multivariate Logistic regression analysis were used to screen possible risk factors for SAP, and ROC curve was used to evaluatethe efficiency of A~2DS~2 score in the diagnosis of SAP.Results There were 44(20.47%) patients with SAP in 215 stroke patients. The univariate analysis showed that age,hypertension, diabetes, smoking history, hypoproteinemia, atrial fibrillation, dysphagia and NIHSS score were all correlated with SAP(P <0.05). The multivariate Logistic analysis showed that smoking history, NIHSS score, atrial fibrillation and dysphagia were the independent predictors of SAP(P<0.05). The incidence of SAP in patients with A~2DS~2 score of≤3 was only 2.27%, while the incidence of SAP in patients whose A~2DS~2 score≥8 was 54.55%. The ROC curve analysis showed that when A~2DS~2 score was 5, it had the highest correct index in the diagnosis of SAP in the elderly. Conclusion A~2DS~2 score is a simple, safe and effective SAP risk assessment method, which can be widely used in clinical application.
引文
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[2]JI R,SHEN H,PAN Y,et al.Novel risk score to predict pneumonia after acute ischemic stroke[J].Stroke,2013,44(5):1303-1309.
[3]ZHANG X,YU S,WEI L,et al.The A2DS2 score as a predictor of pneumonia and in-hospital death after acute ischemic stroke in Chinese populations[J].PLos One,2016,11(3):e0150298.
[4]SMITH CJ,KISHORE AK,VAIL A,et al.Diagnosis of stroke-associated pneumonia:recommendations from the pneumonia in stroke consensus group[J].Stroke,2015,46(8):2335-2340.
[5]黄彦飞,韩敏,罗文静,等.老年脑卒中相关性肺炎病原学特点及危险因素分析[J].中国临床新医学,2015,8(10):972-975.
[6]王娜,王丰容,刘芦姗.急诊病房脑卒中相关性肺炎的危险因素及预后分析[J].中国康复理论与实践,2017,23(8):932-936.
[7]SHANG Y,WANG S,BAI X,et al.Application of A2DS2 score for predicting post-stroke pneumonia in elderly patients[J].Nan Fang Yi Ke Da Xue Xue Bao,2013,33(11):1615-1619.
[8]毛保义,郭岩,刘立立,等.A2DS2评分联合降钙素原预测早发性卒中相关性肺炎的临床研究[J].医学与哲学(B),2018,39(2):43-46.
[9]周丽,宋霜,王敏杰,等.综合气道护理对重症肺炎患儿治疗及呼吸道感染的影响[J].中华医院感染学杂志,2017,27(22):5251-5254.
[10]王琳,胡玉芳,郦明芳,等.经皮左心耳封堵术在心房颤动脑卒中患者中应用的围手术期护理[J].护士进修杂志,2015,30(15):1393-1395.
[11]杨秀华,徐彩玲,徐翠福,等.时间护理结合酸刺激对脑卒中吞咽障碍患者恢复的影响[J].现代中西医结合杂志,2017,26(31):3532-3534.
[12]吕银红,宋效玲,鲍文娅,等.老年脑卒中吞咽障碍患者早期鼻饲的临床护理观察[J].中华全科医学,2014,12(10):1672-1673.
[13]颜美霞,程瑞莲,张晴,等.针对性护理干预对重症脑卒中伴吞咽困难病人营养状态的效果分析[J].全科护理,2017,15(1):37-39.
[14]张艳,郭妍芳.心理护理对老年高血压脑卒中恢复期伴焦虑症状患者的临床效果探讨[J].实用临床医药杂志,2014,18(12):11-13.