作者：王昆1 ，李军文2 ，曾翔1 ，王兆兰3 ，郭雅乐3

单位：

1.610500四川省成都市，成都医学院护理学院　2.610095四川省成都市第一人民医院护理部　3.610075四川 省成都市，成都中医药大学护理学院

Units：

1.School of Nursing, Chengdu Medical College, Chengdu 610500, China 2.Nursing Department, Chengdu First People's Hospital, Chengdu 610095, China 3.School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China

关键词：

卒中；卒中相关性肺炎；危险因素；Meta分析

Keywords：

Stroke; Stroke-associated pneumonia; Risk factors; Meta-analysis

CLC：

R 743.33

DOI：

10.12114/j.issn.1008-5971.2024.00.043

Funds：

四川省科学技术厅2022年重点研发计划项目（2022JDKP0019）

摘要：

目的　系统评价中国脑卒中患者发生卒中相关性肺炎（SAP）的危险因素。方法　计算机检索Web of Science、PubMed、Cochrane Library、Embase、中国知网、维普网、中国生物医学文献数据库、万方数据知识服 务平台中关于中国脑卒中患者发生SAP危险因素的研究。检索时限为建库至2023年7月。提取纳入文献的资料，采 用Review Manager 5.4和Stata 14软件进行Meta分析。结果　共纳入31篇文献，共涉及17 556例脑卒中患者，其中发 生SAP 3 237例，SAP患病率为6.16%～66.20%。Meta分析结果显示，年龄增长〔OR=1.07，95%CI（1.03～1.11）， P=0.001〕、年龄≥60岁〔OR=4.00，95%CI（3.36～4.77），P＜0.001〕、吸烟〔OR=4.60，95%CI（3.82～5.54）， P＜0.001〕、肺部基础疾病〔OR=4.08，95%CI（3.02～5.51），P＜0.001〕、心房颤动〔OR=3.55，95%CI （2.58～4.89），P＜0.001〕、脑卒中史〔OR=2.82，95%CI（2.47～3.23），P＜0.001〕、合并糖尿病〔OR=3.35， 95%CI（2.05～5.48），P＜0.001〕、血糖升高〔OR=2.01，95%CI（1.30～3.12），P=0.002〕、吞咽困难〔OR=3.41， 95%CI（2.67～4.35），P＜0.001〕、意识障碍〔OR=2.17，95%CI（1.94～2.43），P＜0.001〕、格拉斯哥昏迷量表 （GCS）评分降低〔OR=3.54，95%CI（2.42～5.17），P＜0.001〕、美国国立卫生研究院卒中量表（NIHSS）评分升 高〔OR=1.25，95%CI（1.11～1.41），P=0.001〕、鼻饲治疗〔OR=5.80，95%CI（3.91～8.61），P＜0.001〕、应用 抑酸药物〔OR=3.54，95%CI（1.21～10.37），P=0.020〕、预防性使用抗生素〔OR=3.71，95%CI（2.39～5.75）， P＜0.001〕、低蛋白血症〔OR=2.47，95%CI（1.84～3.32），P＜0.001〕、白细胞计数增多〔OR=1.26，95%CI （1.18～1.33），P＜0.001〕是中国脑卒中患者发生SAP的危险因素。结论　现有证据表明，年龄增长、年龄≥60岁、 吸烟、肺部基础疾病、心房颤动、脑卒中史、合并糖尿病、血糖升高、吞咽困难、意识障碍、GCS评分降低、NIHSS 评分升高、鼻饲治疗、应用抑酸药物、预防性使用抗生素、低蛋白血症、白细胞计数增多是中国脑卒中患者发生SAP 的危险因素。在临床实践中，应重视这些危险因素，并将其纳入脑卒中患者的综合评估和干预策略中，以降低SAP的 发生率。

Abstract：

Objective To systematically evaluate the risk factors of stroke-associated pneumonia (SAP) in stroke patients in China. Methods Databases including the Web of Science, PubMed, Cochrane Library, Embase, CNKI, VIP, CBM, Wanfang Data were retrieved to search for studies on the risk factors of SAP in stroke patients in China. The search period was from inception of the database to July 2023. The data of the included literature were extracted, Review Manager 5.4 and Stata 14 was used for meta-analysis. Results A total of 31 articles were included, and involving 17 556 stroke patients, among them, 3 237 cases developed SAP, resulting in a SAP incidence rate ranging from 6.16 % to 66.20 % . Meta-analysis results showed that increased age [OR=1.07, 95%CI (1.03-1.11) , P=0.001] , age ≥ 60 years [OR=4.00, 95 %CI (3.36-4.77) , P < 0.001] , smoking [OR=4.60, 95%CI (3.82-5.54) , P < 0.001] , basic lung diseases [OR=4.08, 95%CI (3.02-5.51) , P < 0.001] , atrial fibrillation [OR=3.55, 95%CI (2.58-4.89) , P < 0.001] , history of stroke [OR=2.82, 95%CI (2.47-3.23) , P < 0.001] , diabetes mellitus [OR=3.35, 95%CI (2.05-5.48) , P < 0.001] , hyperglycemia [OR=2.01, 95%CI (1.30-3.12) , P=0.002] , dysphagia [OR=3.41, 95%CI (2.67-4.35) , P < 0.001] , disturbance of consciousness [OR=2.17, 95%CI (1.94-2.43) , P < 0.001] , decreased Glasgow Coma Scale (GCS) score [OR=3.54, 95%CI (2.42-5.17) , P < 0.001] , increased National Institute of Health Stroke Scale (NIHSS) score [OR=1.25, 95%CI (1.11-1.41) , P=0.001] , nasogastric therapy [OR=5.80, 95%CI (3.91-8.61) , P < 0.001] , acid-suppressing medication application [OR=3.54, 95%CI (1.21-10.37) , P=0.020] , preventive use of antibiotics [OR=3.71, 95%CI (2.39-5.75) , P < 0.001] , hypoproteinemia [OR=2.47, 95%CI (1.84-3.32) , P < 0.001] , increased white blood cell count [OR=1.26, 95%CI (1.18-1.33) , P < 0.001] were the risk factors of SAP in stroke patients in China. Conclusion The available evidence shows that increased age, age ≥ 60 years, smoking, basic lung diseases, atrial fibrillation, history of stroke, diabetes mellitus, hyperglycemia, dysphagia, disturbance of consciousness, decreased GCS score, increased NIHSS score, nasogastric therapy, acid-suppressing medication application, preventive use of antibiotics, hypoproteinemia, increased white blood cell count are the risk factors of SAP in stroke patients in China. In clinical practice, these risk factors should be prioritized and incorporated into the comprehensive assessment and intervention strategies for stroke patients to reduce the incidence of SAP.

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