脑卒中患者卒中后肺炎发生的危险因素分析

赵康路; 李雪松; 叶卫江; 刘文兵; 陈晓玲; 夏秋华

doi:10.16766/j.cnki.issn.1674-4152.004196

脑卒中患者卒中后肺炎发生的危险因素分析

doi: 10.16766/j.cnki.issn.1674-4152.004196

赵康路¹,
李雪松¹,
叶卫江^{1, 2, ,},
刘文兵^{1, 2},
陈晓玲¹,
夏秋华¹

1.
浙江康复医疗中心(浙江中医药大学附属第三医院康复院区)医院感染管理科，浙江杭州 310051
2.
浙江中医药大学附属第三医院感染科，浙江杭州 310051

基金项目:

浙江省中医药科技计划项目 2222

浙江康复医疗中心院级课题 ZKXZ2403

详细信息

通讯作者:
叶卫江，E-mail：1321979460@qq.com

中图分类号: R743.3 R563.1
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出版历程
- 收稿日期: 2025-05-21

Risk factors for poststroke pneumonia in stroke patients

1.
Zhejiang Rehabilitation Medical Center (Rehabilitation Hospital Area of the Third Affiliated Hospital of Zhejiang Chinese Medical University), Hospital Infection Management Department, Hangzhou, Zhejiang 310051, China

摘要

摘要: 目的分析脑卒中患者卒中后肺炎发生的危险因素，为临床提前干预提供依据，以期减少卒中后肺炎的发生，改善预后。方法选取2023年1—10月在浙江康复医疗中心接受治疗的441例脑卒中恢复期患者，收集记录患者性别、年龄，有无意识障碍、吞咽困难，有无侵入性操作，有无冠心病、高血压、高脂血症等并发症，血白细胞、红细胞、血小板，血清钾、钠、糖化血红蛋白等指标，根据入院3周内是否发生肺炎，将患者分为肺炎组(71例)和非肺炎组(370例)。统计卒中后肺炎的发生情况，采用非条件多因素logistic回归分析脑卒中患者卒中后发生肺炎的危险因素。结果 441例患者中男性293例、女性148例，年龄为(58.58±13.60)岁。卒中后肺炎发生率为16.10%(71/441)。肺炎组和非肺炎组年龄、意识障碍、吞咽障碍、有无侵入性操作、糖化血红蛋白比较差异均有统计学意义(P<0.05)。非条件多因素logistic回归模型分析显示，年龄>60岁、合并意识障碍、合并吞咽障碍、糖化血红蛋白＞7.5%是影响脑卒中并发肺炎的独立危险因素(P<0.05)。结论脑卒中患者卒中后肺炎的发生与年龄、合并意识障碍、吞咽障碍、糖化血红蛋白升高有一定关联，应加强相关危险因素的干预，降低脑卒中患者发生肺炎的风险，改善患者预后。
- 脑卒中 /
- 肺炎 /
- 危险因素
Abstract: Objective This study aimed to analyze the risk factors for poststroke pneumonia in stroke patients to enable early intervention, reduce its incidence, and improve patient outcomes. Methods A total of 441 stroke patients who received treatment at Zhejiang Rehabilitation Medical Center from January 2023 to October 2023 were selected. The demographic data (gender, age), clinical variables (consciousness disorder, dysphagia, whether invasive procedures), complications (coronary heart disease, hypertension, hyperlipidemia), and laboratory parameters (white blood cells, red blood cells, platelets, serum potassium, serum sodium, and glycosylated hemoglobin) were recorded. Based on the occurrence of poststroke pneumonia within 3 weeks of admission, they were divided into the pneumonia group and the non-pneumonia group. The occurrence of poststroke pneumonia was statistically analyzed, and the risk factors for poststroke pneumonia in stroke patients were analyzed. Results Among 441 patients including 293 males and 148 females, with an average age of (58.58±13.60) years. The incidence of poststroke pneumonia was 16.10% (71/441). Univariate analysis of poststroke pneumonia identified age, consciousness disorder, dysphagia, invasive procedures, and glycosylated hemoglobin as influencing factors for poststroke pneumonia in stroke patients (P<0.05). Unconditional multivariate logistic regression model analysis demonstrated that age >60 years, presence of consciousness disorder, dysphagia, and glycosylated hemoglobin >7.5% were independent risk factors for poststroke pneumonia in stroke patients (P<0.05). Conclusion The occurrence of poststroke pneumonia in stroke patients is correlated with age, consciousness disorder, dysphagia, and elevated glycosylated hemoglobin. Early identification and targeted management of these factors are necessary to reduce the risk of poststroke pneumonia in stroke patients and improve the prognosis of patients.
- Stroke /
- Pneumonia /
- Risk factors
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表 1 2组脑卒中恢复期患者各指标比较

Table 1. Comparison of indicators across the two groups of stroke recovery patients

项目	肺炎组(n=71)	非肺炎组(n=370)	统计量	P值
性别[例(%)]			1.755^a	0.185
男性	52(73.24)	241(65.14)
女性	19(26.76)	129(34.86)
年龄(x±s，岁)	71.73±12.09	57.32±13.07	8.615^b	<0.001
意识障碍[例(%)]			6.843^a	0.009
有	17(23.94)	45(12.16)
无	54(76.06)	325(87.84)
吞咽障碍[例(%)]			32.152^a	<0.001
有	55(77.46)	151(40.81)
无	16(22.54)	219(59.19)
有无侵入性操作[例(%)]			16.740^a	<0.001
有	60(84.51)	218(58.92)
无	11(15.49)	152(41.08)
高血压病[例(%)]			0.220^a	0.639
有	34(47.89)	166(44.86)
无	37(52.11)	204(55.14)
高脂血症[例(%)]			0.213^a	0.644
有	46(64.79)	229(61.89)
无	25(35.21)	141(28.11)
冠心病[例(%)]			0.165^a	0.685
有	30(42.25)	166(44.86)
无	41(57.75)	204(55.14)
白细胞(x±s，×10⁹/L)	6.57±1.87	6.73±1.95	0.671^b	0.502
血小板(x±s，×10¹²g/L)	228.83±70.63	238.27±74.03	0.991^b	0.322
血清钠(x±s，mmol/L)	138.86±5.44	139.05±5.46	0.266^b	0.790
血清钾(x±s，mmol/L)	4.40±0.56	4.46±0.58	0.853^b	0.394
糖化血红蛋白(x±s，%)	6.41±1.20	5.83±0.98	3.825^b	<0.001
注：^a为χ²值，^b为t值。

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表 2 变量赋值情况

Table 2. Variable assignment

变量	赋值方法
年龄	＞60岁=1，≤60岁=0
意识障碍	有=1，无=0
吞咽障碍	有=1，无=0
侵入性操作	有=1，无=0
糖化血红蛋白	＞7.5%=1，≤7.5%=0

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表 3 脑卒中恢复期患者并发肺炎影响因素的多因素分析

Table 3. Multivariate analysis of factors influencing pneumonia in patients during the stroke recovery phase

变量	B	SE	Waldχ²	P值	OR值	95% CI
年龄	0.097	0.014	48.922	<0.001	1.102	1.072~1.132
意识障碍	-0.955	0.339	7.916	0.005	1.385	1.198~1.748
吞咽障碍	-1.686	0.318	28.170	<0.001	1.185	1.099~1.345
侵入性操作	-1.391	0.350	15.760	0.060	1.249	1.125~1.494
糖化血红蛋白	0.613	0.143	18.318	<0.001	1.846	1.394~2.445

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