摘要
目的：对缺血性卒中患者用A2DS2评分工具对卒中相关性肺炎（SAP）进行风险评估。方法回顾性分析2009年至2011年武汉市市中心医院神经内科收治的缺血性卒中患者1279例并进行 A2DS2评分，A2DS2评分工具：年龄（Age）≥75岁为1分，心房颤动（atrial fibrillation）为1分，吞咽困难（dysphagia）为2分，男性（male sex）为1分；卒中严重程度（stroke severity）：NIHSS评分0～4分为0分，5～15分为3分，≥16分为5分。根据A2DS2评分分为3组：0分组620例，1～9分组383例，≥10分组276例，将三组进行对照分析。SAP诊断标准为：卒中发生后胸部影像学检测发现新出现或进展性肺部浸润性病变，同时合并2个以上临床感染症状：（1）发热≥38℃；（2）新出现的咳嗽，咳痰或原有呼吸道疾病症状加重，伴或不伴胸痛；（3）肺实变体征，和（或）湿啰音，（4）外周血白细胞≥10×10^9 L^-1或≤4×10^9 L^-1，伴或不伴核左移，同时排除某些与肺炎临床表现相近的疾病如：肺结核、肺部肿瘤、非感染性肺间质病、肺水肿、肺栓塞、肺不张等病。三组患者分别进行SAP发生率、病死率以及与缺血性卒中部位的相关性分析，计量资料呈正态分布的用均数±标准差（x ±s），采用t检验，计数资料用百分比表示，采用χ^2检验。结果 A2 DS2评分≥10分组其卒中相关性肺炎的发生率明显高于1～9分及0分组（71.7％vs．22.7％，71.7％vs．3.7％），≥10分组其病死率明显高于1～9分及0分组（16.7％vs．4.96％，16.7％vs．0.3％），SAP组后循环脑梗死及跨MCA、ACA分布区梗死发生率较非SAP组的患者明显增高（35.1％vs．10.1％）（11.4％vs．7.5％），差异具有统计学意义，≥10分组非发酵菌感染率明显增高。结论 A2 DS2评分为卒中相关性肺炎提供了一个危险分层依据，对于A2DS2评分≥10分的急性缺血性卒中患者需要加强措施预防SAP发生。
Objective To assess the risk assessment of stroke associated pneumonia （SAP ） in patients with ischemic stroke using A2DS2 score.Methods A total of 1279 patients with ischemic stroke who were admitted and treated in our department from 2009 to 201 1 were retrospectively analyzed and applicated A2DS2 score.A2DS2 score was calculated as follows：Age ≥75 years=1,atrial fibrillation=1, dysphagia=2,male sex=1;stroke severity：NIHSS score 0-4=0,5-15 =3,≥16=5.The patients were divided into three groups according to A2DS2 score：620 in score 0 group,383 in score 1-9 group,276 in score ≥10 group.The three groups were comparatively analyzed.The diagnostic criteria for SAP were as follows：newly emerging lesions or progressively infiltrating lesions in post-stroke chest images combined with more than two of the following clinical symptoms of infection：（1 ）fever ≥38 ℃;（2 ）newly occurred cough,productive cough or exacerbation of preexisting respiratory tract symptoms with or without chest pain;（3）signs of pulmonary consolidation and/or moist rales;（4）peripheral white blood cell count≥10 ×10^9 L^-1 or≤4 ×10^9 L^-1 with or without nuclear shift to left,while excluding some diseases with similar clinical manifestations to pneumonia, such as tuberculosis, pulmonary tumors, non-infectious interstitial lung disease,pulmonary edema,pulmonary embolism and atelectasis.Analysis of the incidence and mortality of SAP as well as the correlation with ischemic stroke site were performed in the three groups,respectively. Mean ± standard deviation （x ±s）was used to represent measurement data with normal distribution and t test was used.Percentage was used to represent enumeration data and χ^2 test was used.Results The incidence of SAP was significantly higher in A2DS2 score ≥10 group compared with those in score 1-9 and score 0 groups （7 1.7%vs..22.7%,7 1.7%vs..3.7%,respectively）,whereas the mortality in score ≥10 group was significantly higher than those in score 1-9 and score 0 groups （16.7%vs.4.96%,16.7%vs.0.3%,respectively）.The incidences of cerebral infarction in posterior circulation and cross-MCA, ACA distribution areas were significantly higher in SAP group compared with those in non-SAP group （35.1%vs.10.1%,11.4%vs.7.5%,respectively）.The incidence of non-fermentative bacteria infection was significantly increased in score ≥10 group.Conclusions A2DS2 score provides a basis for risk stratification of SAP.The prevention of SAP needs to be strengthened in acute ischemic stroke patients having a A2DS2 score ≥10.
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2014年第6期684-687,共4页
Chinese Journal of Emergency Medicine
