Zhongguo cuzhong zazhi (Oct 2022)
急性卒中患者住院期间感染的临床特征及危险因素分析 Clinical Characteristics and Risk Factors of Infection in Patients with Acute Stroke during Hospitalization
Abstract
目的 探讨急性卒中患者住院期间感染的临床特征及危险因素，为制订感染预防策略提供思路。 方法 连续纳入2019年6月-2021年6月首都医科大学附属北京天坛医院神经内科收治的缺血性卒中（ischemic stroke，IS）、脑出血（intracerebral hemorrhage，ICH）及蛛网膜下腔出血（subarachnoid hemorrhage，SAH）患者，对其临床资料进行回顾性分析。根据患者住院期间是否发生感染分为感染组和非感染组，比较2组的临床特征、感染部位及时间分布，采用单因素及多因素logistic回归分析感染的危险因素。 结果 共纳入2884例急性卒中患者，男性2138例（74.1%），IS 2049例，ICH 531例，SAH 304例。426例患者住院期间出现感染，发生率为14.8%，感染发生的中位时间为卒中后4（1～7）d。IS、ICH及SAH患者的感染率分别为10.8%、21.3%和29.9%，呈逐渐升高趋势。肺脏为急性卒中后感染率最高且最早出现的感染部位。多因素分析显示，年龄增长（OR 1.038，95%CI 1.026～1.050，P＜0.001）、合并心力衰竭（OR 2.339，95%CI 1.197～4.572，P=0.013）、慢性阻塞性肺疾病（OR 3.297，95%CI 1.676～6.486，P=0.001）、卒中类型为脑出血（OR 2.162，95%CI 1.548～3.021，P＜0.001）或蛛网膜下腔出血（OR 8.271，95%CI 5.591～12.236，P＜0.001）、入院NIHSS升高（OR 1.162，95%CI 1.132～1.193，P＜0.001）及住院时间延长（OR 1.138，95%CI 1.109～1.168，P＜0.001）为急性卒中患者住院期间发生感染的独立危险因素。 结论 感染是急性卒中患者常见的并发症之一，其中肺部感染发生率高且发病时间早。年龄升高、合并心力衰竭或慢性阻塞性肺疾病、神经功能损伤较重的患者感染发生率升高，与IS相比，ICH和SAH患者的感染发生率升高。 Abstract: Objective To investigate the clinical characteristics and risk factors of infection in patients with acute stroke during hospitalization, and to provide clinical guidance for the infection prevention strategies. Methods The patients with either ischemic stroke (IS), intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH) who were admitted to Beijing Tiantan Hospital from June 2019 to June 2021 were included in this retrospective study. According to having post-stroke infection or not during hospitalization, patients were divided into infection group and non-infection group. The clinical characteristics, infection sites and time distribution were compared between two groups. Univariate and multivariate logistic regression analysis were used to determine the risk factors for post-stroke infection. Results A total of 2884 patients with acute stroke were enrolled, including 2138 (74.1%) males, 2049 patients with IS, 531 patients with ICH, and 304 patients with SAH. 426 (14.8%) patients developed infection during hospitalization, with a median infection time of 4 (1-7) days after stroke. The infection rates were 10.8%, 21.3% and 29.9% in patients with IS, ICH and SAH, respectively, showing a significant increasing trend. Lung was the highest and earliest infection site in patients with acute stroke. Multivariate analysis showed that increasing age (OR 1.038, 95%CI 1.026-1.050, P<0.001), heart failure (OR 2.339, 95%CI 1.197-4.572, P=0.013), chronic obstructive pulmonary disease (OR 3.297, 95%CI 1.676-6.486, P=0.001), ICH (OR 2.162, 95%CI 1.548-3.021, P<0.001), SAH (OR 8.271, 95%CI 5.591-12.236, P<0.001), increased NIHSS score at admission (OR 1.162, 95%CI 1.132-1.193, P<0.001) and prolonged hospital stay (OR 1.138, 95%CI 1.109-1.168, P<0.001) were risk factors for infection during hospitalization in patients with acute stroke. Conclusions Infection is one of the most common complications in patients with acute stroke, and pulmonary infection had a high incidence and the onset time was early. Patients with advanced age, heart failure, chronic obstructive pulmonary disease, and severe neurological impairment usually had an increased incidence of infection. Patients with ICH and SAH had an increased incidence of infection, compared with patients with IS.
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