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目的分析卒中相关性肺炎(SAP)的危险因素。方法观察发病24h内入住神经科ICU的急性缺血性脑卒中患者63例2周内SAP发生情况,进行自主神经功能评估和相关检查。结果 63例中,2周内发生SAP 33例(52.38%)。SAP组患者的NIHSS评分和APACHEⅡ评分均高于非SAP组,洼田吞咽能力评分和淋巴细胞计数低于非SAP组(P<0.05)。在17例SAP患者和15例非SAP患者进行了心率变异性(HRV)分析。结果显示,SAP患者HRV指标无明显变化,而非SAP患者的LF(低频)值后期较前期明显增高(P<0.05)。结论急性缺血性脑卒中患者的神经功能损伤,尤其是吞咽功能障碍和疾病严重程度是SAP发生的危险因素。这可能与卒中导致自主神经功能紊乱有关。
Objective To analyze the risk factors of stroke-associated pneumonia (SAP). Methods Sixty-three patients with acute ischemic stroke admitted to Neurology ICU within 24 hours after onset of onset of disease were analyzed in 2 weeks. The autonomic nerve function was evaluated and correlated. Results Among the 63 cases, SAP occurred in 33 cases (52.38%) within 2 weeks. The NIHSS score and APACHE Ⅱ score of SAP group were higher than those of non-SAP group, but the scores of swallowing ability and lymphocyte count were lower in SAP group than those in SAP group (P <0.05). Heart rate variability (HRV) analysis was performed in 17 SAP patients and 15 non-SAP patients. The results showed that there was no significant change in HRV index in patients with SAP, while those in non-SAP patients were significantly higher (P <0.05) at the later stage. Conclusion Neurological impairment, especially swallowing dysfunction and disease severity, are risk factors for SAP in patients with acute ischemic stroke. This may be related to autonomic dysfunction caused by stroke.