脑卒中后肺炎临床诱发因素及分析

Clinical Precipitating Factors and Analysis of Stroke-Associated Pneumonia

摘要: 目的：探讨脑卒中后患者诱发肺炎的因素，分析并提高卒中相关性肺炎(Stroke-associate pneumonia SAP)治疗及预防水平。方法：对2010年1月1日~2015年12月31日两院急诊科脑卒中后并发肺炎的180名患者的临床表现，诱发因素及治疗进行回顾性分析。结果：其中99例患者为脑卒中后吞咽困难并发吸入性肺炎，76例为脑卒中后卧床不起所致坠积性肺炎，5例其他因素所致卒中后发生肺炎，全部180例均有中枢神经损伤诱发免疫功能低下的表现。临床表现主要为咳嗽，咯痰和发热。胸部X光检查表现为吸入部位的浸润影及双下肺斑片影。血常规检测：C反应蛋白升高，免疫学检测T细胞亚群中Th绝对减少。所有病例中，反复多次发作116例，治疗后158例存活，18例死亡，4例因经济负担重等原因家属放弃治疗，自动出院。结论：脑卒中后肺炎是导致脑卒中患者死亡的最重要原因之一，必须认真做好早期预防，早期诊断和及早使用抗生素。并引导家属积极配合治疗。

Abstract: Objective: This study is carried out in order to assess clinical precipitating factors of post-stroke pneumonia, to analyze and improve the prevention and treatment of stroke-associated pneumonia (SAP). Method: Retrospective analysis of precipitating factors and treatment based on clinical data was conducted from 180 patients who were diagnosed with SAP in the emergency department in two hospitals during the course from 1/1/2010 to 12/31/2015. Result: Among these patients, 99 patients were post-stroke dysphagia associated with aspiration pneumonia, 76 patients were hypostatic pneumonia caused by bed-ridden associated with post stroke, and 5 post stroke pneumonia were caused by other factors. All of 180 patients show clinical manifestations with stroke induced immunodepression caused by central nervous injury, such as coughing, expectora-tion and fever. Chest X-ray appearance showed infiltration and patchy consolidation in both lower lobes. Blood routing test: C-reactive protein elevated, immunological test showed absolute T helper cell counts decreased. In all cases, 116 patients were recurrent, 158 patients survived after treatment, 18 patients died, and 4 patients were given up by family due to financial burden and voluntarily discharged. Conclusion: SAP is one of the most fatal factors patients with cerebral stroke, therefore early prevention, diagnosis antibiotic therapy and educate family member to cooperate with the therapy were important ways to manage post stroke.