关键词: 老年, 脑卒中, 肺部感染, 危险因素, 因素分析,统计学

Abstract:

Objective: To analyze the prognostic factors of pulmonary infection in hospitalized elderly stroke patients. Methods: The medical records of 1365 elderly stroke patients hospitalized in The Second Rehabilitation Hospital of Shanghai from January 2019 to December 2021 were retrospectively analyzed and the general demographic data, disease data and rehabilitation treatment data of 236 elderly patients with pulmonary infection were analyzed. According to the chest CT imaging data at 2 weeks of treatment, 179 patients (75.85%) had improved pulmonary infection (improved group), and 57 patients (24.15%) had not improved pulmonary infection (not improved group). Univariable and multivariable logistic regression analysis were performed for 17 factors of the two groups: sex, age, education level, smoking history, course and diagnostic type of stroke, complications (diabetes and underlying pulmonary diseases), swallowing disorder, cognitive impairment, BMI, blood albumin, blood hemoglobin, spontaneous cough and sputum excretion ability, lying-bed time, lung rehabilitation training time and gastrointestinal injury. Results: Univariable logistic regression analysis showed that there were significant differences of improvement rate of pulmonary infection in patients with or without age ≥80 years old (72.22% (13/18) and 27.78% (5/18)), swallowing disorder (70.31% (90/128) and 29.69% (38/128)), cognitive impairment (64.49% (69/107) and 35.51% (38/107)), combining with basic lung diseases (54.55% (12/22) and 45.45% (10/22)), no ability of spontaneous cough and sputum excretion (64.06% (41/64) and 35.94% (23/64)), lung rehabilitation training time <2 h/d (56.10% (23/41) and 43.90% (18/41)) and gastrointestinal function impaired (73.33% (66/90) and 26.67% (24/90))(χ² values were 6.255, 4.679, 17.793, 4.402, 6.658, 10.565 and 11.303 respectively, and all values of P were <0.05). Multivariable logistic regression analysis showed that risk factors affecting the prognosis of pulmonary infection in hospitalized elderly stroke patients were cognitive impairment (OR(95%CI)=4.073 (1.904-8.714)), combined with basic lung diseases (OR(95%CI)=2.940 (1.010-8.560)), lung rehabilitation training time <2 h/d (OR(95%CI) =3.010 (1.258-7.203)),no ability of spontaneous cough and sputum excretion (OR(95%CI)=0.195 (0.093-0.406)). Conclusion: In order to improve the prognosis of pulmonary infection, preventive and control measures should be proactively taken for elderly stroke patients with pulmonary infection who have cognitive impairment, complicated with basic pulmonary diseases, no ability of spontaneous cough and sputum excretion, and whose pulmonary rehabilitation time is less than 2 h/d.

Key words: Elderly, Stroke, Pulmonary infection, Risk factors, Factor analysis,statistics