急性脑梗死机械取栓后发生呼吸机相关性肺炎的危险因素分析

范亭亭; 李瑞; 朱余友; 孙文; 胡伟; 王国平

doi:10.16766/j.cnki.issn.1674-4152.003192

急性脑梗死机械取栓后发生呼吸机相关性肺炎的危险因素分析

doi: 10.16766/j.cnki.issn.1674-4152.003192

中国科学技术大学附属第一医院(安徽省立医院)神经内科，安徽合肥 230001

基金项目:

国家自然科学基金青年基金项目 82001452

详细信息

通讯作者:
王国平，E-mail: wgphhh@126.com

中图分类号: R743.3
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出版历程
- 收稿日期: 2023-02-07
- 网络出版日期: 2023-11-23

Risk factors for ventilator-associated pneumonia after mechanical thrombectomy in acute ischemic stroke

Department of Neurology, the First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui 230001, China

摘要

摘要: 目的探讨急性脑梗死机械取栓术后并发呼吸机相关性肺炎(VAP)的危险因素及A2DS2评分量表的预测价值。方法回顾性收集2020年1月—2021年12月在中国科学技术大学附属第一医院神经内科因急性脑梗死行机械取栓住院的273例患者的临床病例资料，根据是否合并VAP分为VAP组(180例)和非VAP组(93例)。对所有患者进行A2DS2评分，采用多因素logistic回归分析探究不同因素与肺炎的关系，采用受试者工作特征曲线(ROC)评价A2DS2量表对VAP的预测价值。结果年龄、住院时间、高血压病史、随机血糖、美国国立卫生研究院卒中量表(NIHSS)评分、中性粒细胞与淋巴细胞比值(NLR)、A2DS2评分与VAP发生相关(均P＜0.05)；住院时间长及既往高血压病史是VAP发生的独立危险因素(OR=1.112，95% CI: 1.053~1.173，P < 0.001;OR=1.970，95% CI: 1.130~3.433，P=0.017)；A2DS2≥5分是VAP发生的独立危险因素(OR=2.412，95% CI: 1.382~4.210，P=0.002)；A2DS2评分量表对VAP有预测价值(AUC为0.651，95% CI：0.580~0.721，灵敏度为0.733，特异度为0.484，最佳截断值为5分)。结论年龄、住院时间、高血压病史、随机血糖、NIHSS评分、NLR、A2DS2评分与VAP发生相关；住院时间长、既往高血压病史、高A2DS2评分是VAP的独立危险因素；A2DS2评分量表对卒中合并VAP有预测价值。
- 急性缺血性脑卒中 /
- 血管内治疗 /
- 呼吸机相关性肺炎 /
- A2DS2评分
Abstract: Objective To investigate the risk factors of ventilator-associated pneumonia (VAP) after mechanical thrombectomy in acute stroke and the predictive value of A2DS2 score scale. Methods From January 2020 to December 2021, the clinical data of 273 patients admitted to the Department of Neurology, the First Affiliated Hospital, University of Science and Technology of China (USTC) for acute cerebral infarction were retrospectively collected. The patients were divided into VAP group (180 cases) and non-VAP group (93 cases). A2DS2 scores were obtained for all patients. Multivariate logistic regression analysis was used to investigate the relationship between various factors and pneumonia. Receiver operating characteristic curve (ROC) was used to evaluate the predictive value of the A2DS2 scale for VAP. Results Age, length of hospital stay, history of hypertension, random blood glucose, NIHSS score, neutrophil to lymphocyte ratio (NLR), A2DS2 score were correlated with VAP (all P < 0.05). length of hospital stay and history of hypertension were independent risk factors for VAP (OR=1.112, 95% CI: 1.053-1.173, P < 0.001; OR=1.970, 95% CI: 1.130-3.433, P=0.017); A2DS2≥5 points was an independent risk factor for VAP (OR=2.412, 95% CI: 1.382-4.210, P=0.002). The A2DS2 score scale had predictive value for VAP (AUC=0.651, 95% CI: 0.580-0.721, sensitivity was 0.733, specificity was 0.484, and optimal cut-off value was 5 points). Conclusion Age, hospitalization days, history of hypertension, random blood glucose, NIHSS score, NLR, A2DS2 score were correlated with VAP. Long hospital stay, history of hypertension and high A2DS2 score were independent risk factors for VAP. The A2DS2 score scale has predictive value for stroke combined with VAP.
- Acute ischemic stroke /
- Endovascular treatment /
- Ventilator-associated pneumonia /
- A2DS2 score

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图 1 A2DS2评分预测VAP的ROC曲线

注：对角段由绑定值生成。

Figure 1. ROC curve of A2DS2 score for predicting VAP

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表 1 VAP组与非VAP组AIS患者基线资料比较

Table 1. Comparison of baseline characteristics between VAP and non-VAP groups in AIS patients

项目	总体(273例)	VAP组(180例)	非VAP组(93例)	统计量	P值
年龄[M(P₂₅, P₇₅)，岁]	67(57，76)	68(58，77)	66(54，73)	-2.188^a	0.029
性别(男性/女性，例)	166/107	112/68	54/39	0.445^b	0.505
住院时间[M(P₂₅, P₇₅)，d]	12(8，16)	13(9，18)	10(8，13)	-4.493^a	<0.001
既往高血压[例(%)]	163(59.7)	118(65.6)	45(48.4)	7.513^b	0.006
既往冠心病[例(%)]	91(33.3)	56(31.1)	35(37.6)	1.174^b	0.279
既往糖尿病[例(%)]	48(17.6)	35(19.4)	13(14.0)	1.264^b	0.261
既往房颤[例(%)]	91(33.3)	59(32.8)	32(34.4)	0.073^b	0.786
既往吸烟[例(%)]	72(26.4)	48(26.7)	24(25.8)	0.011^b	0.918
既往饮酒[例(%)]	56(20.5)	34(18.9)	22(23.6)	1.031^b	0.310
收缩压[M(P₂₅, P₇₅)，mmHg]	135(120，153)	137(119，157)	131(121，150)	-1.378^a	0.168
血糖[M(P₂₅, P₇₅)，mmol/L]	7.340(6.190，8.560)	7.505(6.403，9.103)	7.03(5.705，7.995)	-2.910^a	0.004
中性粒细胞计数[M(P₂₅, P₇₅)，10⁹/L]	7.940(6.365，9.350)	8.030(6.425，9.453)	7.57(6.280，9.090)	-1.334^a	0.182
淋巴细胞计数[M(P₂₅, P₇₅)，10⁹/L]	1.170(0.865，1.570)	1.160(0.860，1.485)	1.220(0.905，1.670)	-1.227^a	0.220
NLR[M(P₂₅, P₇₅)]	6.800(4.630，9.660)	7.020(4.980，10.640)	5.790(4.360，8.590)	-2.023^a	0.043
肌酐[M(P₂₅, P₇₅)，μmol/L]	66.00(56.00，81.00)	67.50(57.25，81.75)	64.00(54.00，77.50)	-0.927^a	0.354
尿酸[M(P₂₅, P₇₅)，μmol/L]	296(235，368)	301(235，371)	280(230，351)	-0.812^a	0.417
NIHSS评分[M(P₂₅, P₇₅)，分]	14(11，18)	15(12，19)	13(10，15)	-3.333^a	0.001
A2DS2评分[M(P₂₅, P₇₅)，分]	5(4，7)	6(4，7)	4(4，6)	-4.151^a	<0.001
前循环卒中[例(%)]	39(14.3)	28(15.6)	11(11.8)	0.696^b	0.404
注: ^a为Z值，^b为χ²值。1 mmHg=0.133 kPa。

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表 2 AIS患者发生VAP影响因素的多因素logistic回归分析

Table 2. Multivariable logistic regression analysis of risk factors for VAP in patients with AIS

项目	B	SE	Wald χ²	P值	OR(95% CI)
住院时间	0.106	0.028	14.665	<0.001	1.112(1.053~1.173)
既往高血压病史	0.678	0.283	5.724	0.017	1.970(1.130~3.433)
随机血糖	0.102	0.067	2.305	0.129	1.107(0.971~1.262)
NLR	0.018	0.033	0.321	0.571	1.020(0.956~1.086)
A2DS2≥5分	0.881	0.284	9.604	0.002	2.412(1.382~4.210)

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