卒中后肺炎的五个危险因素

Risk Factors for Chest Infection in Acute Stroke

急性卒中肺部感染的危险因素

A Prospective Cohort Study

一项前瞻性队列研究

Background and Purpose— Pneumonia is a major cause of morbidity and mortality after stroke. We aimed to determine key characteristics that would allow prediction of those patients who are at highest risk for poststroke pneumonia.

背景和目的——肺炎是卒中后主要的并发症和死亡原因，我们的研究旨在明确对卒中后肺炎高危患者有预测作用的重要特征。

Methods— We studied a series of consecutive patients with acute stroke who were admitted to hospital. Detailed evaluation included the modified National Institutes of Health Stroke Scale; the Abbreviated Mental Test; and measures of swallow, respiratory, and oral health status. Pneumonia was diagnosed by set criteria. Patients were followed up at 3 months after stroke.

方法——我们连续纳入了一些因急性卒中而入院的患者。详细的评估包括改良的美国国立卫生院卒中量表、简易智力测试量表、吞咽和呼吸测试，以及口腔卫生状况评估。肺炎的诊断按照确定的诊断标准进行，病人随访至卒中后3个月。

Results— We studied 412 patients, 391 (94.9%) with ischemic stroke and 21 (5.1%) with hemorrhagic stroke; 78 (18.9%) met the study criteria for pneumonia. Subjects who developed pneumonia were older (mean±SD age, 75.9±11.4 vs 64.9±13.9 years), had higher modified National Institutes of Health Stroke Scale scores, a history of chronic obstructive pulmonary disease, lower Abbreviated Mental Test scores, and a higher oral cavity score, and a greater proportion tested positive for bacterial cultures from oral swabs. In binary logistic-regression analysis, independent predictors (P<0.05) of pneumonia were age >65 years, dysarthria or no speech due to aphasia, a modified Rankin Scale score 4, an Abbreviated Mental Test score <8, and failure on the water swallow test. The presence of 2 or more of these risk factors carried 90.9% sensitivity and 75.6% specificity for the development of pneumonia.

结果——我们对412例患者进行了研究，其中缺血性卒中391例(94.9%)，出血性卒中21例(5.1%) 。共有78例(18.9%) 出现了肺炎，肺炎患者年龄偏大( 75.9±11.4 vs 64.9±13.9 岁)，改良的美国国立卫生院卒中量表分数较高，常有慢性阻塞性肺病病史，简易智力测试量表分数较低，口腔评分较高，口腔拭子细菌培养阳性率较高。在二元logistic回归分析中，肺炎的独立预测因素为年龄>65岁、构音障碍或失语症、改良Rankin量表4级、简易智力测试量表<8和吞咽水试验失败。这些危险因素中存在两个或两个以上，预测发生肺炎的敏感度为90.9%，特异度为75.6%。

Conclusions— Pneumonia after stroke is associated with older age, dysarthria/no speech due to aphasia, severity of poststroke disability, cognitive impairment, and an abnormal water swallow test result. Simple assessment of these variables could be used to identify patients at high risk of developing pneumonia after stroke.

结论——卒中后肺炎与高龄、构音障碍/失语症、卒中后残疾的严重程度、认知功能损害和吞咽水试验异常有关。对这些变量的简单评估有助于识别卒中后肺炎的高危患者。

编译：

高龄构音障碍认知下降等因素可预测卒中后肺炎的发生率

肺炎是卒中后常见的并发症和死亡原因，最近一期《Stroke》杂志上苏格兰研究人员的一篇文章称，高龄、构音障碍/失语症、卒中后残疾的严重程度、认知功能损害和吞咽水试验异常都与卒中后肺炎相关，对这些变量的评估可用于识别卒中后肺炎的高危患者。（Stroke 2007 38: 2284 - 2291）

格拉斯哥皇家医院和格拉斯哥口腔医院的研究人员在一项前瞻性队列研究中，连续纳入了412例因急性卒中而入院的患者。对这些患者进行详细的评估，包括改良的美国国立卫生院卒中量表、简易智力测试量表、吞咽和呼吸测试，以及口腔卫生状况评估。肺炎的诊断按照既定的诊断标准进行，病人随访至卒中后3个月。

412例患者中缺血性卒中391例(94.9%)，出血性卒中21例(5.1%) 。至随访结束共有78例(18.9%) 患者出现了肺炎，肺炎患者年龄偏大( 75.9±11.4 vs 64.9±13.9 岁)，改良的美国国立卫生院卒中量表分数较高，常有慢性阻塞性肺病病史，简易智力测试量表分数较低，口腔评分较高，口腔拭子细菌培养阳性率较高。在二元logistic回归分析中，肺炎的独立预测因素为年龄>65岁、构音障碍或失语症、改良Rankin量表4级、简易智力测试量表<8和吞咽水试验失败。同时有两个或两个以上这些危险因素，预测发生肺炎的敏感度为90.9%，特异度为75.6%。