急性脑梗塞并发肺部感染的临床研究
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摘要
目的探讨急性脑梗塞并发肺部感染相关的诱发机制及影响因素,以便有效的预防和控制肺部感染的发生。
方法通过回顾性分析2007年1月至2009年2月我科收治的1100例急性脑梗塞患者,其中并发肺部感染188例的流行病学资料、既往史、病情严重程度、治疗及预后,再具体分析肺部感染的发生率与患者性别、年龄、吸烟饮酒史、慢性基础病、梗塞程度、意识状态、吞咽功能、侵袭性操作、预防性抗感染治疗及预后的关系。
结果男性、高龄、既往合并有卒中及肺部疾患者、梗塞面积大、昏迷者、存在吞咽功能障碍和侵袭性操作的患者肺部感染发生率明显增高。吸烟饮酒史、预防性抗感染治疗与急性脑梗塞后合并肺部感染的发生无显著关系。合并肺部感染的脑梗塞患者病死率明显高于无肺部感染者。
结论预防和控制肺部感染可有效提高急性脑梗塞的救治成功率并可改善预后。
Subject:In order to prevent and control the occurrence of pulmonary infection effectively, we investigate the evoking mechanisms and influencing factors in patients with acute cerebral infarction complicated with pulmonary infection.
Methods:We investigate the epidemiological information, history of past illness, seriousness degree of diseases, treatment and prognosis of 1100 acute cerebral infarction cases in our department from January, 2007 to February,2009, including 188 cases complicated with pulmonary infection. Then we analysis the relationship between pulmonary infection rate and gender, age, smoking and drinking histories, basic chronic diseases and illness degree, infarction degree, state of consciousness, swallowing function, invasive operation, preventive anti-infection therapy, prognosis of the patients.
Results:The pulmonary infection rate increased obviously in patient who is male, aged, associated with stroke and lung diseases, accepting invasive operation and has severe illness, coma, swallowing dysphagia. Smoking and drinking histories, preventive anti-infection therapy and acute cerebral infarction lung infections had no significant relationship. Patients with cerebral infarction complicated pulmonary infections have obviously higher fatality than patients without lung infection.
Conclusion:Preventing and controlling pulmonary infection can effectively improve the treatment and prognosis of acute cerebral infarction.
方法通过回顾性分析2007年1月至2009年2月我科收治的1100例急性脑梗塞患者,其中并发肺部感染188例的流行病学资料、既往史、病情严重程度、治疗及预后,再具体分析肺部感染的发生率与患者性别、年龄、吸烟饮酒史、慢性基础病、梗塞程度、意识状态、吞咽功能、侵袭性操作、预防性抗感染治疗及预后的关系。
结果男性、高龄、既往合并有卒中及肺部疾患者、梗塞面积大、昏迷者、存在吞咽功能障碍和侵袭性操作的患者肺部感染发生率明显增高。吸烟饮酒史、预防性抗感染治疗与急性脑梗塞后合并肺部感染的发生无显著关系。合并肺部感染的脑梗塞患者病死率明显高于无肺部感染者。
结论预防和控制肺部感染可有效提高急性脑梗塞的救治成功率并可改善预后。
Subject:In order to prevent and control the occurrence of pulmonary infection effectively, we investigate the evoking mechanisms and influencing factors in patients with acute cerebral infarction complicated with pulmonary infection.
Methods:We investigate the epidemiological information, history of past illness, seriousness degree of diseases, treatment and prognosis of 1100 acute cerebral infarction cases in our department from January, 2007 to February,2009, including 188 cases complicated with pulmonary infection. Then we analysis the relationship between pulmonary infection rate and gender, age, smoking and drinking histories, basic chronic diseases and illness degree, infarction degree, state of consciousness, swallowing function, invasive operation, preventive anti-infection therapy, prognosis of the patients.
Results:The pulmonary infection rate increased obviously in patient who is male, aged, associated with stroke and lung diseases, accepting invasive operation and has severe illness, coma, swallowing dysphagia. Smoking and drinking histories, preventive anti-infection therapy and acute cerebral infarction lung infections had no significant relationship. Patients with cerebral infarction complicated pulmonary infections have obviously higher fatality than patients without lung infection.
Conclusion:Preventing and controlling pulmonary infection can effectively improve the treatment and prognosis of acute cerebral infarction.
引文
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[2]中华医学会神经病学分会脑血管病学组急性缺血.性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010[J].中华神经科杂志,2010,43(2)：146-153.
[3]Adams HP, Adams RJ, Brott T, et al. Guidelines for the Early Management of Patients With Ischemic Stroke, A Scientific Statement From the Stroke Council of the American Stroke Association.Stroke.2003,34(10):1056-1083.
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[5]Hinchey JA, Shephard T, et al. Formal dysphagia screening protocols prevent pneumonia.Sroke.2005,36(9):1972-1976.
[6]Kwon HM, Jeong SW, Lee SH, et al.The pneumonia score:a simple grading scale for prediction of pneumonia after acute stroke[J]. Am J Infect Control 2006,34(2):64-68.
[7]饶明俐,主编.中国脑血管病防治指南.北京：人民卫生出版社,2007.
[8]中华神经科学会中华神经外科学会.各类脑血管病诊断要素[J].中华神经科杂志,1996,29(6)：379-380.
[9]卫生部医政司.医院感染诊断标准(试行)[S].卫生部关于印发《医院感染诊断标准(试行)》的通知,2001.
[10]Davenport RJ Dennis MS Wellwood I. Complications after acute stroke[J].Stroke,1996, 27:415-420.
[11]Sellars C, Bowie L, Bagg J, et al.Risk factors for chest infection in acute stroke:A prospective cohort study [J].Stroke,2007,12(8):594-595.
[12]Chamorro A, Amaro S, Vargas M, et al. Catecholamines, infection,and death in acute ischemic stroke. J Neurol Sci,2007,252(1):29-35.
[13]Urra X, Obach V, Chamorro A. Stroke induced immunodepression syndrome:from bench to bedside. Curr Mol Med,2009,9(2):195-202.
[14]Khatri P, Hill MD, Palesch YY, et al.Methodology of the Interventional Management of Stroke Ⅲ trial. Int J Stroke,2008,3(2):130-137.
[15]蒋辉华,崔可,林琳.急性脑梗死后并发肺部感染的临床研究[J].临床医学,2008,28(5)：13-14.
[16]Hamidon BB, Raimond AA. Risk factors and complications of acute ischaemic stroke patients at hospital University kebangasan Malaysia (HUKM)[J]. Med J. M.2003,58 (4): 499-505.
[17]Camerlingo M, Casto L, Censori B, et al. Recurrence after first cerebral infarction in young adults[J]. Acta Neurol Scand,2000,102(2):87-93.
[18]Yana Vinogradova, Julia Hippisley-Cox and Carol Coupland. Identification of new risk factors for pneumonia:population-based case-control study, British Journal of General Practice, 2009,9:329-338.
[19]Paul E,Mark MD,et al. Aspiration pneumonia and dysphagia in the elderly. Chest.2003,124(7):328-336.
[20]Sharma G, Goodwin J. Effect of aging on respiratory system physiology and immunology. Clin Intern Aging,2006,1(3):253-260.
[21]温汉春,朱继金,张志哲.脑卒中获得性院内肺炎危险因素分析.中风与神经疾病杂志.2004,21(5)：437-439.
[22]Katzan IL,Cebul RD,et al.The effect of pneumonia on mortality among patients hospital for acute stroke.Neurology.2003,60(2):620-625.
[23]李秀文,员伟强.青年卒中的危险因素[J].中国误诊学杂志,2005,5：1819-1921.
[24]Santonja JM, Vicent V, Pareja A. Cerebrovascular disease in young adults:a study of its course in 167 patients. Rev Neurol,1998,26:787-789.
[25]吕一欣,任南,吴安华,等.脑卒中患者医院内获得性肺炎危险因素探讨.中华神经科杂志,2005,38：258-260.
[26]李瑶宣,李燕华等.脑卒中患者医院内获得性肺炎危险因素分析.中国急救医学.2006,26(1)：1-4.
[27]Nakajoh K,Nakagawa T,et al.Relation between incidence of pneumonia and protective reflex in post-stroke patients with oral or tube feeding. Inter Med.2000,247(1):39-42.
[28]Jennifer A, Frontera MD, et al. Hyperglycemia after SAH:predictors, associated complications, and impact on outcome.Stroke.2006,37(1):199-203.
[29]Mamun K,Lim J.Role of nasogastric tube in preventing aspiration pneumonia in patients with dysphagia. Singapore Med J.2005,46(11):627-631.
[30]Krassen Nedeltchev, Nora Renz, Alexander Karameshev, et al:Predictors of early mortality after acute ischaemic stroke, SWISS MED WKLY 2010,140(17-18):254-259.
[31]Zuliani G, Cherubini A, Ranzini M, Ruggiero C, Atti AR, Fellin R. Risk factors for short-term mortality in older subjects with acute ischemic stroke. Gerontology.2006;52:231-6.
[32]Halkes PH, van Gijn J, Kappelle LJ, Koudstaal PJ, Algra A. Classification of cause of death after stroke in clinical research.Stroke.2006;37:1521-4.
[33]Walter U,Knoblich R, et al. Predictors of pneumonia in acute stroke patients admitted to a neutologicao intensive care unit.J Neurol.2007,14 [Epub ahead of print]
[34]Gracies JM.Pathophysiology of impairment in patients with spasticity and use of stroke as a treatment of spatic hypertonia.Phys Med Rehabil Clin N AM.2001,12(4):747-768.
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