| ?Background?Stroke-associated pneumonia(SAP)is a common complication of ischemic stroke,increasing the patients' hospitalization days and expenses,and affecting the prognosis.Whether we can assess the possibility of SAP in advance,that is,to assess the risk factors of SAP and understand the etiology characteristics of SAP in this area,and take effective preventive measures in time,is the problem we want to solve in this study.?Objective? To establish a predictive scoring system for SAP in patients with ischemic stroke,and to analyze the etiological characteristics of SAP.?Materials and methods?Retrospectively collected 2016.01.01-2017.05.31 at first affiliated hospital of fujian medical university neurology accords with the standard set of acute cerebral infarction patients.Collectting the age,gender,time of onset,severity(location,NIHSS,CGS score),medical history(hypertension,diabetes,heart failure,atrial fibrillation),smoking history,albumin,creatinine,drug use(PPI),hospitalization time and cost,the pathogenic results.Chi-square test and independent sample T-test were used to screen out the factors that had statistically significant impact on the occurrence of pneumonia,and to conduct multiple regression analysis,and converted them into the corresponding scores in the prediction scoring system.?Results?1016 cases of acute ischemic stroke were collected,and 138 cases were combined with SAP,and the incidence rate of SAP was 13.58%.Through Chi-square test and correction T-test,age,stroke location,onset time,NIHSS,GCS score,dysphagia,atrial fibrillation,heart failure,serum creatinine,use of PPI had a significant impact on the occurrence of SAP,and the multivariate regression analysis showed that age,the NIHSS,GCS score,dysphagia,heart failure,creatinine and use of PPI were considered independent correlation with SAP standard coefficient(?)were 0.121,0.118,0.084,0.319,0.087,0.067,0.085,respectively,with each ?value removed to the minimum score is obtained: aged 2,NIHSS more than 16 points 2 points(5-15 points: 1 points),GCS score less than or equal to 8 points and 1.5 points(9-12 points,1 points),dysphagia in 5,heart failure 1.5,creatinine 1 points,PPI 1.5 points,a total of 14.5 points.The area under the ROC curve was 0.861,95%CI 0.826-0.896(P < 0.05),the critical value was 3,the sensitivity was 84.8%,and the specificity was 75.5%.And compared with the A2DS2 score,it was proved that the occurrence of SAP was well predicted.Among the 1016 ischemic stroke patients,138 cases incorporated SAP.The average days of hospitalization in the group without SAP were 13.13 days,the average cost was ?23217.05,the average days of hospitalization in the SAP group were 16.05 days,and the cost was ?39005.19,the difference was statistically significant(P < 0.05).Among 138 cases of SAP,sputum cultivating was positive in 82 cases,Gram-negative bacteria accounted for the most,accounting for 60.97% of sputum cultivating positive cases,among them 24 cases were Klebsiellosis pneumoniae,21 cases were resistant to piperacillin and ampicillin,and 3 cases were multidrug-resistant bacteria.The second is Gram-positive bacteria,most of which are Staphylococcus aureus(17 cases),and the fungi are rare.?Conclusion?The prediction score table established in this study:(age > 75 years)with 2 points,NIHSS 2 points(5-15 points: 1 points,more than 16 points: 2 points),GCS score of 1.5 points(9-12 points,1 points,1.5 points less than 8 points),dysphagia 5 points,heart failure 1.5 points.Creatinine 1 points,PPI 1.5 points,the critical value of 3 points,the sensitivity and specificity is all good,can contribute to the clinical early identification of high-risk groups,timely intervention in the occurrence and development of SAP.SAP significantly increased hospitalization days and expenses,and the main pathogens were gram negative bacteria,most of them were Klebsiellosis pneumoniae.Gram positive bacteria were mainly Staphylococcus aureus,and were resistant to piperacillin,ampicillin and other commonly used antibiotics. |
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