卒中相关肺炎的神经科管理：优化预防、诊疗及多学科协作

Neurological Management of Stroke-Associated Pneumonia: Optimizing Prevention, Diagnosis-Treatment, and Multidisciplinary Collaboration

摘要: 卒中患者常伴随多种并发症，给家庭和社会带来沉重的负担。卒中相关性肺炎(Stroke-Associated Pneumonia, SAP)的概念由Hilker等于2003年首先提出。SAP定义为非机械通气的卒中患者在发病7 d内新出现、符合改良美国疾病控制与预防中心(Centers for Disease Control and Prevention, CDC)标准的肺炎，给家庭和社会带来沉重的负担。早期识别高风险患者、尽早干预，治疗上建立神经科主导的SAP多学科管理团队，对改善患者预后尤为重要。虽然目前研究在SAP的识别、诊断与治疗方面取得一些进展，但临床仍存在一些争议，如是否需要启用免疫调节治疗及预防性抗生素的时机等。我们建议结合患者风险分层及动态评估，更加个体化和灵活调整预防性抗生素使用时间窗口和时长。通过改善患者免疫功能治疗SAP可能成为一种新的治疗方案，未来应通过高质量研究验证新型干预策略的临床价值。

Abstract: Stroke patients are frequently complicated by multiple comorbidities, posing a substantial burden on families and society. The concept of stroke-associated pneumonia (SAP) was first proposed by Hilker et al. in 2003. SAP is defined as pneumonia newly developed within 7 days post-stroke in non-ventilated stroke patients, meeting the modified Centers for Disease Control and Prevention (CDC) criteria, further exacerbating the societal and familial burden. Early identification of high-risk patients, prompt intervention, and establishing a neurology-led multidisciplinary management team for SAP are critical to improving patient prognosis. Although advancements have been made in the recognition, diagnosis, and treatment of SAP, several clinical controversies persist, such as the necessity of initiating immunomodulatory therapies and the optimal timing of prophylactic antibiotics. We recommend tailoring prophylactic antibiotic regimens to individual patient risk stratification and dynamic clinical assessments, with flexible adjustment of therapeutic windows and duration. Therapies targeting immune function modulation in SAP patients may represent a novel therapeutic strategy, though its clinical value requires validation through high-quality studies.