Possible Cholinergic Mechanism Of SAP And Application Of SAP Score Sheets

Background and objective: Stroke-associated pneumonia is a common complication after stroke,which is an important factor affecting the prognosis of stroke and has high mortality.In recent experiments and clinical evidence,the immunosuppressive state of the subsequent onset of stroke is also one of the reasons for the higher incidence of nosocomial infection.Focal cerebral ischemia directly activates cholinergic anti-inflammatory pathways,the two-phase effect induced by peripheral immune system[1,2],namely early stage of immune activation and subsequent systemic immunosuppression,may increase the risk of infection by reducing secondary nerve injury and accompanying immunosuppression.Through a retrospective analysis,this paper to observe the correlation between the use of anti-choline hydrobromide in patients with acute ischemic stroke and the incidence of stroke-associated pneumonia,to explore the possible cholinergic mechanism of stroke-associated pneumonia,and to use A2DS2 and ACDD4 to predict the risk of stroke-associated pneumonia,So as to provide more new ideas for prevention of stroke-associated pneumonia.Materials and methods: We collected 385 cases of hospitalized patients with acute cerebral infarction of Fujian Medical University First Affiliated Hospital from May 2017 to December 2017,including 323 cases in the control group used routine treatment,62 patients in the treatment group were treated with anticholinergic drug hydrobromide anisodine injection 2mg qd intravenous infusion for at least 7 days.The two groups after treatment were compared using chi square test to assess the occurrence of stroke associated pneumonia and stroke associated pneumonia.All the patients with acute cerebral infarction of the inclusion criteria for A2DS2 and ACDD4 score,using A2DS2 and ACDD4 test ROC curve score prediction efficiency.Results:(1)There were 59 cases of stroke-associated pneumonia in the treatment group,3 cases of stroke-associated pneumonia,the incidence of stroke-associated pneumonia was 5.08%,the control group without the occurrence of stroke-associated pneumonia in 277 cases,46 cases of stroke associated pneumonia and stroke-associated pneumonia incidence rate was 16.61%.Two stroke-associated pneumonia incidence of P <0.05,the difference was statistically significant.(2)A2DS2 scale predicts stroke-associated pneumonia the area under the ROC curve is 0.824,p<0.05,when the A2DS2 is 5,its sensitivity is 69.4%,the specificity is 82.7%,the correct index is the highest,and it has better accuracy in predicting stroke-associated pneumonia.ACDD4 scale predicts stroke-associated pneumonia the area under the ROC curve is 0.814,p<0.05,when the ACDD4 is 2,its sensitivity is 71.4%,the specificity is 85.4%,the correct index is the highest,and it has better accuracy in predicting stroke-associated pneumonia.Conclusion:(1)Anticholinergic drugs inhibit the cholinergic anti-inflammatory pathway Anisodine Hydrobromide Injection acetylcholine receptor antagonist used to restore pulmonary innate immunity,can effectively prevent the occurrence of stroke-associated pneumonia;(2)For patients with acute ischemic stroke using A2DS2 scale and ACDD4 scale prediction of stroke-associated pneumonia.Risk,when A2DS2 is larger than 5 or ACDD4 is larger than 2,suggesting occurrence of stroke associated pneumonia in high-risk groups,should take effective measures to prevent the occurrence of stroke-associated pneumonia,it is worthy of clinical application.