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Objective To detect the serum levels of CC chemokine receptor 2(CCR2)and C-reactive pro-tein(CRP)in stroke patients,and analyze their relationship with the severity of stroke associated pneumonia and their clinical significance.Methods A total of 78 patients with stroke associated pneumonia who were di-agnosed and treated in the hospital from October 2022 to February 2023 were collected as the study group,ac-cording to the severity of pneumonia,the study group was divided into mild group(31 cases),moderate group(29 cases),and severe group(18 cases),78 stroke patients who did not develop pneumonia were included into control group.Pearson method was applied to analyze the correlation between serum CCR2 and CRP levels in stroke associated pneumonia patients.Multivariate Logistic regression was applied to analyze the factors influ-encing the occurrence of stroke associated pneumonia.Receiver operating characteristic(ROC)curve was ap-plied to analyze the diagnostic value of serum CCR2 and CRP for stroke associated pneumonia.Results The National Institute of Health stroke scale(NIHSS)score,serum CCR2,and CRP levels in the study group were obviously higher than those in the control group(P<0.05).The levels of serum CCR2 and CRP increased with the aggravation of pneumonia(P<0.05).The levels of serum CCR2 and CRP in the study group were positively correlated(r=0.799,P<0.05).NIHSS score,CCR2,and CRP levels were risk factors for stroke associated pneumonia in stroke patients(P<0.05).The area under the curve(AUC)for the diagnosis of stroke associated pneumonia using serum CCR2 and CRP alone was 0.873 and 0.888,respectively,and the AUC for the combined detection of the two was 0.936,the combined detection of the two was superior to the individual detection of serum CCR2 and CRP(Zcombination-CCR2=1.987,Zcombination-CRP=1.832,P=0.041,0.047).Conclusion Serum CCR2 and CRP are closely related to the severity of stroke associated pneumonia,and their combined detection has high diagnostic value for stroke associated pneumonia.
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Objective To explore the predictive value of inflammatory markers for stroke-associated pneumonia(SAP)in patients with acute ischemic stroke(AIS)based on the nomogram model.Methods According to whether pneumonia occurred,259 AIS patients were divided into SAP group(81 cases)and non-SAP group(178 cases).The clinical data of the two groups were compared.The systemic inflammatory response index(SIRI),systemic immunoinflammatory index(SII)and neutrophil to lymphocyte ratio(NLR)were calculated according to the formula.The variables with statistically significant differences were included in the multivariate binary Logistic regression model to screen out the independent risk factors for SAP in AIS patients.The independent risk factors were used to construct a predictive model,and the predictive ability of the two models,which only included traditional factors and included inflammatory indicators at the same time,was further compared from the aspects of discrimination,calibration,clinical practicability and so on.Reclassification analysis was used to evaluate the extent to which the nomogram model improved the predictive value of SAP risk in AIS patients.Results Compared with those in the non-SAP group,the rates of smoking,diabetes,dysphagia,leukocytes,neutrophils,lymphocytes,triglyceride level,NIHSS score on admission,SIRI,SII and NLR were significantly increased in the SAP group,and the rate of hypertension was decreased(all P＜0.05).Diabetes mellitus(OR =2.505,95%CI:1.070-5.850,P =0.034),dysphagia(OR =3.492,95%CI:1.501-8.119,P =0.004),NIHSS score on admission(OR = 1.310,95%CI:1.188-1.446,P＜0.001),SIRI(OR =2.417,95%CI:1.327-4.401,P =0.008),NLR(OR =1.434,95%CI:1.101-1.860,P =0.007)were independent risk factors for SAP in AIS patients.The area under the curve was 0.788(95%CI:0.725-0.852,P＜0.001)for the prediction model without inflammatory factors and 0.884(95%CI:0.838-0.930,P＜0.001)for the prediction model with independent risk factors.The calibration curve showed a good consistency between the predicted risk and the observed results.The decision curve showed that the model had a significant net benefit for predicting SAP.In addition,by calculating the net reclassification index(NRI)and the comprehensive discriminant improvement index(IDI),it was found that the nomogram model had a significant improvement in predicting the risk of SAP in AIS patients.Internal verification also proves the reliability of the nomogram model.Conclusions SIRI and NLR are independent predictors of SAP in AIS patients on admission.Adding SIRI and NLR to the traditional model can significantly improve the ability to identify the risk of SAP occurrence in AIS patients.
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Objective To analyze the scores of National Institutes of Health stroke scale(NIHSS),geriatric nutritional risk index(GNRI),motor function in dependence measure(MFIM)and the risk of stroke-related pneumonia(SAP).Methods Patients with stroke admitted from November,2021 to May,2022 were included.The scores of NIHSS,GNRI and MFIM at admission were collected,and they were divided into non-SAP group(n=232)and SAP group(n=86)according to whether pneumonia occurred within one week after stroke.According to the receiver operating characteristic(ROC)curve,the predictive ability of each score to SAP was evaluated,and each score was grouped according to the best cut-off point.logistic regression model and restricted cubic spline were used to analyze the relationship between each score and SAP.Results A total of 318 stroke patients were enrolled in the study including 86 in SAP group and 232 in non-SAP group.Logistic regression shows that,levels of NIHSS score(OR=32.783,95％CI:16.366～65.671,P<0.001),MFIM score(OR=0.052,95％CI:0.027～0.100,P<0.001)and GNRI score(OR=0.262,95％CI:0.144～0.476,P<0.001)were associated with SAP.Restricted cubic spline analysis shows that,there was a nonlinear dose-response relationship between SAP risk and NIHSS score(P-general trend<0.001,P-nonlinear=0.002),GNRI score(P-general trend<0.001,P-nonlinear<0.001).Conclusion NIHSS,MFIM,and GNRI scores are associated with the risk of SAP in stroke patients,and some of them have nonlinear relationships.
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Objective:To observe any therapeutic effect of combining early pulmonary rehabilitation training with acupuncture at the back-shu and front-mu acupoints in treating stroke-associated pneumonia (SAP).Methods:Eighty SAP patients were randomly divided into a treatment group and a control group, each of 40. Both groups were given routine symptomatic treatment for pneumonia, nutritional support, lipid-lowering and anti-infection measures, as well as acupuncture at the back-shu and front-mu acupoints. The treatment group additionally received pulmonary rehabilitation training. Before and after 14 days of the treatment, both groups were evaluated in terms of their forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), peak flow rate (PEF), white blood cell count (WBC), C-reactive protein (CRP), and procalcitonin (PCT). Chinese medicine (TCM) scores for expectoration of phlegm, shortness of breath, pulmonary rales, cough, fever and weakness were also assigned. The duration of antibiotic use and intensive care unit (ICU) stay were compared between the two groups.Results:Treatment efficacy was significantly higher in the treatment group (97.5%) than in the control group (85.0%). The treatment group′s average duration of antibiotic use and ICU stay were significantly shorter than in the control group. The treatment improved the average FVC, FEV1, PEF, WBC, CRP and PCT of both groups significantly leaving the average FVC and PEF of the treatment group significantly higher than the control group′s average, but its average WBC, CRP, PCT and the total TCM syndrome score significantly lower.Conclusions:Combining early pulmonary rehabilitation training with acupuncture at the back-shu and front-mu acupoints has a definite therapeutic effect on SAP patients. It can significantly shorten the use of antibiotics and ICU stay, promote the recovery of lung function, reduce inflammation and relieve clinical symptoms.
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ObjectiveTo explore the effects of modified Gualou Zhishitang combined with piperacillin sodium and tazobactam sodium on the immune function and serum levels of inflammatory cytokines in the patients with stroke-associated pneumonia （SAP， syndrome of phlegm-heat accumulation in lung）. MethodEighty SAP patients with the syndrome of phlegm-heat accumulation in lung were randomized into a control group （40 cases） and a study group （40 cases）. The SAP patients in the control group were treated with piperacillin sodium and tazobtam sodium， while those in the study group were treated with modified Gualou Zhishitang on the basis of the treatment in the control group for 2 consecutive weeks. The clinical therapeutic effects， immune function indexes， inflammation indexes， and lung function of SAP patients in the two groups before and after treatment were determined and compared. ResultAfter treatment， the scores of lesion， pulmonary rales， cough， fever， phlegm color， and constipation in both groups decreased （P<0.05）. After treatment， the ratio of forced expiratory volume in the first second to forced expiratory volume （FEV1/FVC） and forced expiratory volume in the first second as percentage of predicted value（FEV1%） in both groups improved （P<0.05）， and the study group outperformed the control group （P<0.05）. The treatment decreased the neutrophil to lymphocyte ratio （NLR） in the two groups （P<0.05）， and the study group had lower NLR than the control group after treatment （P<0.05）. The serum levels of procalcitonin （PCT） and hypersensitive C-reactive protein （hs-CRP） in both groups declined after treatment （P<0.05）， and the declines were more significant in the study group than in the control group （P<0.05）. After treatment， the study group was better than the control group （P<0.05）. The treatment in both groups elevated the levels of CD3+， CD4+， and CD4+/CD8+ in the peripheral blood and lowered the level of CD8+ （P<0.05）， and the changes were more significant in the study group than in the control group （P<0.05）. The total response rate of the study group was 95.00% （38/40）， which was higher than that （80.00%， 32/40） of the control group （χ2=4.114，P<0.05）. There was no significant difference in the incidence of adverse reactions between the two groups. ConclusionModified Gualhou Zhishitang combined with piperacillin sodium and tazobactam sodium demonstrates a significant therapeutic effect on the SAP patients with the syndrome of phlegm-heat accumulation in lung. This therapy can mitigate the clinical symptoms， improve the lung function， lower the serum levels of inflammatory cytokines， and improve the immune capacity， with high safety.
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ObjectiveTo investigate the association between serum 25-hydroxy vitamin D [25(OH)D] and the occurrence and outcome of stroke-associated pneumonia (SAP) in patients with acute ischemic stroke (AIS) in emergency ward. MethodsThe clinical data of 256 patients with AIS from January, 2019 to December, 2021 were collected in the emergency department of Beijing Bo'ai Hospital. Blood routine, biochemical indicators and serum concentration of 25(OH)D were detected within 24 hours after enrollment; meanwhile, National Institute of Health Stroke Scale (NIHSS) and A2DS2 score were evaluated. The patients were divided into non-SAP group (n = 164) and SAP group (n = 92) according to whether pneumonia occurred during hospitalization. Multivariable logistic regression model was used to analyze the influencing factors of SAP. The predictive ability of serum 25(OH)D and A2DS2 for SAP were evaluated by receiver operating characteristic (ROC) curves. The 28-day survival of patients with SAP was followed up. Multivariable Cox proportional hazard regression model was used to investigate the association between vitamin D nutritional status and 28-day all-cause mortality. ResultsSerum 25(OH)D was significantly lower in the SAP group than that in the non-SAP group (Z = 6.896, P < 0.001). After adjusting age, sex, infarct volume, A2DS2 score and other factors, lower serum 25(OH)D level (OR = 0.934, 95%CI 0.884 to 0.986, P = 0.014) was an independent risk factor for SAP. The areas under curve (95%CI) of serum 25(OH)D, A2DS2 score and their combined model for predicting SAP were 0.774 (0.718 to 0.824), 0.832 (0.781 to 0.876) and 0.851 (0.802 to 0.893) (P < 0.001), respectively; and the optimum cut-off values were 25(OH)D < 10.2 ng/mL, A2DS2 score > 5 points, combined prediction > 0.207, and the Youden index were 0.493, 0.662 and 0.616, respectively. A2DS2 score could improve the prediction efficiency of serum 25(OH)D (Z = 2.106, P = 0.035). After adjusting age, sex, infarct volume and NIHSS score, vitamin D deficiency was an independent risk factor for all-cause mortality after 28 days of SAP (HR = 2.871, 95%CI 1.004 to 8.208, P = 0.049) . ConclusionSerum 25(OH)D is independently associated with the occurrence and outcome of SAP in patients with AIS in emergency ward, which could serve as an independent predictor for SAP.
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ObjectiveTo explore the risk factors of stroke-associated pneumonia (SAP) for patients with mild to moderate acute ischemic stroke (AIS). MethodsFrom October, 2016 to December, 2019, 321 patients with mild to moderate AIS in Beijing Bo'ai Hospital were collected and divided into SAP group (n = 71) and non-SAP group (n = 250) according to whether they were complicated with SAP. Gender, age, time from symptom onset to admission, systolic pressure, diastolic pressure, scores of National Institutes of Health Stroke Scale (NIHSS) at admission, and medical history were recorded. Laboratory indexes including the count of white blood cell and platelet, levels of D-dimer, hypersensitive C-reactive protein (hs-CRP) and α-hydroxybutyrate dehydrogenase (α-HBDH) were measured. ResultsUnivariate analysis showed that age, NIHSS score, history of hypertension, atrial fibrillation, prior cerebral infarction, the count of white blood cell and platelet, the levels of D-dimer, hs-CRP and α-HBDH were the influencing factors of SAP (P < 0.2). Multivariate Logistic regression showed that age > 70 years old (OR = 7.121, 95%CI 3.493 to 14.514, P < 0.001), NIHSS score > 4 (5 to 10, OR = 4.861, 95% CI 2.412 to 9.797, P < 0.001), the count of platelet > 300×109/L (OR = 6.978, 95% CI 1.864 to 26.128, P = 0.004), and the level of D-dimer > 1.0 mg/L (OR = 3.036, 95% CI, 1.518 to 6.071, P = 0.002) were the risk factors of SAP. The model fitted the original data well (HL = 1.509，P = 0.680) and appeared a good prediction (AUC = 0.847, 95% CI 0.796 to 0.898, P < 0.001). ConclusionAge > 70 years old, NIHSS score > 4 (5 to 10), the count of platelet > 300×109/L and the level of D-dimer > 1.0 mg/L were the risk factors of SAP for patients with mild to moderate AIS.
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Background:Stroke is the second leading cause of death worldwide. In the acute phase, stroke patients are susceptible to complications like chest infections, cardiac dysfunction, and urinary tract infections. Globally, the incidence of pneumonia among stroke patients is e stimated to be around 14%. The A2DS2 score (age, atrial fibrillation [AF], dysphagia, sex, and stroke severity using the National Institutes of Health Stroke Scale[NIHSS] score) is a simple scoring system to find risk of stroke associated pneumonia (SAP). Here our aim is planned to assess the risk of SAP in patients with acute stroke using the A2DS2 score.Material And Methods:This prospective observational study was conducted on patients with Ischemic stroke, time from symptom onset within 7 days and Age > 18 years admitted in tertiary care hospital. NIHSS score and A2DS2 score were calculated on admission. Follow up of all thepatients was done during their hospital stay and those who fulfilled Mann’s diagnostic criteria for pneumonia were diagnosed as SAP. Result:Out of 110 patients (M:60, F:50, Mean age 60.37+7.07), the commonest comorbidity was Hypertension (85, 77.27%) andthe commonest symptom was Facial Asymmetry (73, 66.4%). Among these, 19 (18.8%) patients developed SAP. Patients with SAP had higher mean age, male preponderance, commonest symptom dysphagia, higher NIHSS score and higher A2DS2 score. Patients with acute ischemic stroke who had high A2DS2 scores (5-10) higher risk of developing SAP and worse outcome (P <0.05). Conclusion:In conclusion, patients in the high A2DS2 score group had higher incidence of SAP and non-favourable outcome compared to patients with low A2DS2 scores who had more favourable outcomes
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Objective To analyze the risk factors and pathogen drug resistance of senile stroke-associated pneumonia (SAP), and to provide references for early clinical intervention. Methods A total of 859 elderly patients with cerebral stroke admitted to our hospital from June 2018 to June 2020 were selected and divided into the study group (SAP, n=375) and the control group (no SAP, n=484) according to the occurrence of stroke associated pneumonia. Clinical data of age, gender, and other complications of the two groups were analyzed. The sputum culture and drug sensitivity test of senile SAP patients were analyzed. Results A total of 313 pathogens were detected in 375 SAP patients, including 211 strains of gram-negative bacteria (67.41%), mainly consisting of 92 Acinetobacter baumannii (29.39%), 54 Pseudomonas aeruginosa (17.25%), and 42 Klebsiella pneumoniae (13.42%), and 73 strains (23.32%) of gram-positive bacteria, mainly 62 strains of Staphylococcus aureus (19.81%). In addition, there were 29 strains of fungi (9.27%). Pseudomonas aeruginosa was highly sensitive to piperacillin/tazobactam and ceftazidime. Acinetobacter baumannii and Klebsiella pneumoniae were highly sensitive to imipenem, meropenem, and cefoperazone sodium and sulbactam sodium. Staphylococcus aureus and Enterococcus were highly sensitive to teicolanin, linezolid and vancomycin. The proportion of patients aged ≥80 years old, mechanical ventilation, bed rest and use of prophylactic antibiotics in the experimental group was significantly higher than that in the control group (P<0.05). Logistic regression analysis showed that age ≥80 years, mechanical ventilation, hypoproteinemia and use of prophylactic antibiotics were independent risk factors for SAP (P<0.05). Conclusion The main pathogens of stroke-associated pneumonia in the elderly are Pseudomonas aeruginosa, Staphylococcus aureus and Acinetobacter baumannii. It is necessary to rationally choose antibiotics according to the results of drug sensitivity. The risk factors are patients' age ≥ 80 years old, mechanical ventilation, and bed rest. Clinicians should attach great importance to the prevention of stroke-related pneumonia in the elderly.
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To systematically evaluate the efficiency and safety of Tanreqing Injection in the treatment of stroke-associated pneumonia(SAP). Seven domestic and foreign databases(CNKI, Wanfang, VIP, CBM, PubMed, Cochrane Library, EMbase) were retrieved from the establishment to July 2020. According to the inclusion and exclusion criteria, randomized controlled trial of the effect of Tanreqing Injection in the treatment of SAP was selected. NoteExpress software was used to screen out literatures. RevMan 5.4 software was used for data analysis. GRADE system was used to evaluate the evidence quality of the outcome indicators. A total of 1 755 cases in 21 studies were retrieved, including 879 cases in experimental group and 876 cases in control group. In general, the quality of stu-dies received was not high. According to Meta-analysis,(1) in terms of shortening the length of hospital stay, Tanreqing Injection combined with conventional western medicine was better than conventional western medicine(MD=-4.04, 95%CI[-4.43,-3.65], P<0.000 01);(2) in terms of increasing effective rate, Tanreqing Injection combined with conventional western medicine was better than conventional western medicine(RR=1.22, 95%CI[1.17, 1.27], P<0.000 01);(3) in terms of reducing inflammation indicators, Tanreqing Injection combined with conventional western medicine was better than conventional western medicine(MD_(CRP)=-10.75, 95%CI[-15.61,-5.88], P<0.000 01; MD_(WBC count)=-1.62, 95%CI[-2.55,-0.69], P=0.000 6; MD_(PCT)=-0.58, 95%CI[-0.89,-0.26], P=0.000 3];(4) in terms of improving symptoms and signs, Tanreqing Injection combined with conventional wes-tern medicine was better than conventional western medicine(MD_(cough)=-2.73, 95%CI[-4.93,-0.53], P=0.02; MD_(antipyretic)=-1.07, 95%CI[-1.17,-0.98), P<0.000 01];(5) in terms of decreasing the NIHSS scores, Tanreqing Injection combined with conventional western medicine was better than conventional western medicine(MD=-3.02, 95%CI[-4.91,-1.13], P=0.002);(6) in terms of adverse reactions, there was no statistically significant difference between Tanreqing Injection combined with conventio-nal western medicine compared with conventional western medicine treatment(RR=1.19, 95%CI[0.61,2.29], P=0.61). GRADE system showed that the evidence levels of above outcome indicators were low and extremely low. The results proved that Tanreqing Injection combined with conventional western medicine had a good advantage in the treatment of SAP, with better observation indicators better than western medicine conventional treatment, and no increase in the incidence of adverse reactions. However, this study had certain limitations. The overall quality of the included studies was low, which affected the reliability of the results. Therefore, the conclusions of this study shall be used cautiously.
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Humains , Médicaments issus de plantes chinoises , Pneumopathie infectieuse/traitement médicamenteux , Reproductibilité des résultats , Accident vasculaire cérébral/traitement médicamenteuxRÉSUMÉ
@#Objective To analyze the risk factors of stroke-associated pneumonia (SAP) in patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis.Methods A total of 798 patients with AIS who received intravenous thrombolysis therapy with alteplase from the Department of Neurology,Yangpu Hospital,Tongji University from January 2016 to December 2020 were retrospectively selected and divided into pneumonia group and non-pneumonia group according to the presence or the absence of SAP.The clinical of the two groups were compared.Multivariate logistic regression analysis was used to analyze the independent risk factors of SAP.Results Of 798 cases,115 cases occurred SAP.By multivariate logistic regression analysis,age≥70 years(OR=2.846,95%CI 2.311~5.083,P<0.001),diabetes(OR=2.291,95%CI 1.601~3.945,P=0.003),chronic obstructive disease(OR=2.064,95%CI 1.759~3.528,P=0.005),NIHSS score at admission>8(OR=1.814,95%CI 1.502~2.452,P<0.001),unconsciousness(OR=2.325,95%CI 2.005~3.404,P=0.008),dysphagia(OR=2.457,95%CI 2.221~4.017,P<0.001),hemorrhagic transformation(OR=1.828,95%CI 1.653~2.523,P=0.012) were independent risk factors of SAP in AIS patients treated with intravenous thrombolysis.Conclusion Age≥70 years,diabetes,chronic pulmonary disease,NIHSS score at admission,unconsciousness,dysphagia,hemorrhagic transformation were independent risk factors of SAP in AIS patients treated with thrombolysis.
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@#Objective to investigate the relationship between systemic immune-inflammation index （SII） and stroke-associated pneumonia （SAP） in acute ischemic stroke（AIS） patients. Methods AIS patients prospectively admitted to the First Affiliated Hospital of Zhengzhou University from January 2015 to December 2016.We recorded demographic characteristics and its blood routine results to calculate SII. Univariate and multivariate logistic regression analysis was used to assess the relationship between SII and SAP. The receiver operating characteristic （ROC） curve analysis was used to evaluate the predictive value of SII to SAP. Results A total of 641 patients were included which 50（7.80%）had SAP. SII was higher in the SAP group［564.00（385.71，856.46）vs 1191.33（843.71，2120.91），P<0.001］. Multivariable analysis showed the risk of SAP in the highest quartile group was increased by 8.083 times. the difference was statistically significant（95%CI 2.673~24.442；P<0.001）. The receiver operating characteristic （ROC） curve analysis showed that the area under the curve of SII was 0.781（P<0.0001）. the cut-off value for predicting SAP was 810.84，the sensitivity and specificity was 80.0%and 71.9%. Conclusion SII was an potential independent risk factor for acute ischemic stroke（AIS） patients to predict SAP.
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Objective To explore the effect of early pulmonary rehabilitation on stroke associated pneumonia by the ICU specialist nurses. Methods Totally 40 cases of stroke patients from January 2017 to June 2017 were selected into the control group, and 44 cases of stroke patients from July 2017 to December 2017 were set as the intervention group. The patients in the control group were given routine care, and those in the experimental group were given early pulmonary rehabilitation in addition to routine care by ICU specialist nurses. The clinical outcome such as the occurrence of SAP, the length of intensive care units (ICU) stay and the duration of mechanical ventilation were compared. Results The incidence of SAP in the intervention group was 13.64% (6/44), significantly lower than that 32.50(13/40) in the control group ( χ2=4.26﹐P＜0. 05)﹐and the length of ICU stay the duration of mechanical ventilation were (5.59±3.93), (3.2±0.84)days﹐which were lower than (8.50±7.89),((13.13±9.58)days in the control group (t=2.106,2.678﹐P＜0.05), the prealbumin levels was(219.43±59.71)mg/L,higher than(192.20±54.85) mg/L in the control group(t=-2.170﹐P＜0.05), the difference was statistically significant. Conclusion Early pulmonary rehabilitation can effectively reduce the incidence of SAP and better clinical outcome. And we also should improve the SAP risk assessment and the management of swallowing and nutrition.
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Objective To establish a nursing risk assessment index system (NRAIS) for stroke-associated pneumonia (SAP), and provide reference for the prevention and control of SAP.Methods On the basis of literature analysis and semi-structured interviews, the basic framework of NRAIS for SAP was preliminarily drawn up. Indexes were screened by using Delphi method and analytic hierarchy process, the weight of index was calculated.Results The NRAIS for SAP consisting of 6 first-level indexes and 33 second-level indexes was constructed, positive coefficient of expert of two rounds consultation were 88.89％ and 100％ respectively, authoritative coefficients was 0.8％.Conclusion The constructed assessment index system can effectively help managers identify high-risk factors and high-risk links of SAP, and provide evaluation basis for effective prevention of clinical nursing risks.
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Chief physician Wang Fade is involved in the third and fourth batches of instructors to inherit the academic experiences of veteran Chinese medicine in China, and he is good at treating stroke and related diseases. The stroke-associated pneumonia (SAP) refers to the stroke patients originally without pulmonary infection contract the pulmonary parenchymal inflammatory infection, and the stroke patients are in the SAP onset crowd group. There is no name of SAP in traditional Chinese medicine (TCM). Chief physician Wang Fade believes that SAP belongs to the categories of "cough syndrome" or "asthma syndrome" in TCM. From the etiological analysis, SAP is neither due to external cause nor internal cause, but belongs to not internal and external cause. Strictly speaking, SAP is due to an external cause. The pathogenesis of SAP is due to the mistake of inhalation and accumulation, evil toxins directly enter into the lungs, obstructing the lung qi, transforming into heat and production of phlegm, phlegm and heat together forming obstruction of Qi mechanism, inducing loss of lung clearance, leading to the occurrence of cough, asthma, phlegm, fever and other syndromes. Although the location of SAP is mainly in the lungs, the spleen, stomach, liver, kidney, large intestine and other visceral organs can also be involved. According to clinical experiences, SAP can be divided into 3 types of syndrome: phlegm-heat obstructing the lung, phlegm-dampness obstructing the lung and lung-yin deficiency. In the treatment of acute stage, eliminating pathogens is the main method, such as clearing heat, resolving phlegm, eliminating dampness and depressing qi, etc, while in the middle and late stages, eliminating pathogens and strengthening qi are combined. According to which being the priority, the healthy energy or the evil, the following measures can be used: when evil being significant in the disease and the patient's health basically alright, eliminating evil is the main therapy and promoting the healthy energy secondary; when the evil is not very obvious in the disease, and the patient's general condition is relatively weak, consolidating the healthy energy is the main therapy, and eliminating evil secondary.
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Objective@#To explore the effect of early pulmonary rehabilitation on stroke associated pneumonia by the ICU specialist nurses.@*Methods@#Totally 40 cases of stroke patients from January 2017 to June 2017 were selected into the control group, and 44 cases of stroke patients from July 2017 to December 2017 were set as the intervention group. The patients in the control group were given routine care, and those in the experimental group were given early pulmonary rehabilitation in addition to routine care by ICU specialist nurses. The clinical outcome such as the occurrence of SAP, the length of intensive care units (ICU) stay and the duration of mechanical ventilation were compared.@*Results@#The incidence of SAP in the intervention group was 13.64%(6/44), significantly lower than that 32.50(13/40) in the control group (χ2=4.26, P<0. 05), and the length of ICU stay the duration of mechanical ventilation were (5.59±3.93), (3.2±0.84)days, which were lower than (8.50±7.89), ((13.13±9.58)days in the control group (t=2.106,2.678, P<0.05) , the prealbumin levels was (219.43±59.71) mg/L,higher than (192.20±54.85) mg/L in the control group (t=-2.170, P<0.05) , the difference was statistically significant.@*Conclusion@#Early pulmonary rehabilitation can effectively reduce the incidence of SAP and better clinical outcome. And we also should improve the SAP risk assessment and the management of swallowing and nutrition.
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Stroke-associated pneumonia (SAP) is a spectrum of pulmonary infections in non-mechanical ventilation patients within 7 days of stroke. SAP is one of the most common complications after stroke, with an incidence of 7%-38%, which is significantly associated with poor prognosis of stroke. Stroke-induced immune-depression syndrome (SIDS) is one of the main pathogenesis of SAP, which is closely related to autoimmune, sympathetic nervous system (SNS), hypothalamic-pituitary-adrenalin axis (HPA axis), parasympathetic nervous system (PNS), and damage-related molecular patterns (DAMPs). It is unclear how the lungs and brain interact during the development of SAP. Some clinical studies have found that some clinical indicators such as monocyte human leukocyte antigen-DR (mHLA-DR), neutrophil to lymphocyte ratio (NLR) and heart rate variability (HRV) can be used to predict SAP occurrence. Old age, male, and diabetes are currently considered risk factors for SAP. Furthermore, a variety of SAP risk scales such as A2DS2 scale (age, atrial fibrillation, dysphagia, gender and stroke severity), preventive antibacterial therapy in acute ischemic stroke (PANTHERIS) scale, acute ischemic stroke-associated pneumonia scale (AIS-APS), and ISAN scale (pre-stroke independence, gender, age, and stroke severity) have been developed. According to the opinion of Pneumonia in Stroke Consensus in 2015, it is recommended to use the modified Centers for Disease Control and Prevention (CDC) pneumonia clinical diagnostic criteria for the diagnosis of SAP. Prevention of SAP is the most important part of clinical practice. Preventive antibiotics are not recommended, and once SAP is diagnosed, the antibiotic strategies should be followed. Neuroprotective and anti-inflammatory treatments are still being studied.
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Stroke-associated pneumonia (SAP) is a spectrum of pulmonary infections in non-mechanical ventilation patients within 7 days of stroke. SAP is one of the most common complications after stroke, with an incidence of 7%-38%, which is significantly associated with poor prognosis of stroke. Stroke-induced immune-depression syndrome (SIDS) is one of the main pathogenesis of SAP, which is closely related to autoimmune, sympathetic nervous system (SNS), hypothalamic-pituitary-adrenalin axis (HPA axis), parasympathetic nervous system (PNS), and damage-related molecular patterns (DAMPs). It is unclear how the lungs and brain interact during the development of SAP. Some clinical studies have found that some clinical indicators such as monocyte human leukocyte antigen-DR (mHLA-DR), neutrophil to lymphocyte ratio (NLR) and heart rate variability (HRV) can be used to predict SAP occurrence. Old age, male, and diabetes are currently considered risk factors for SAP. Furthermore, a variety of SAP risk scales such as A2DS2 scale (age, atrial fibrillation, dysphagia, gender and stroke severity), preventive antibacterial therapy in acute ischemic stroke (PANTHERIS) scale, acute ischemic stroke-associated pneumonia scale (AIS-APS), and ISAN scale (pre-stroke independence, gender, age, and stroke severity) have been developed. According to the opinion of Pneumonia in Stroke Consensus in 2015, it is recommended to use the modified Centers for Disease Control and Prevention (CDC) pneumonia clinical diagnostic criteria for the diagnosis of SAP. Prevention of SAP is the most important part of clinical practice. Preventive antibiotics are not recommended, and once SAP is diagnosed, the antibiotic strategies should be followed. Neuroprotective and anti-inflammatory treatments are still being studied.
RÉSUMÉ
Objective To investigate the predictive value of intracerebral hemorrhage (ICH) score for stroke-associated pneumonia (SAP) in patients with primary intracerebral hemorrhage. Methods From January 2014 to July 2015,209 consecutive patients with ICH at the Emergency Department,Shanghai Jiading District Central Hospital were enrolled retrospectively.The general information of the patients were analyzed. They were divided into either a SAP group (n=73) or a non-SAP group (n=136) according to whether they had SAP or not.Based on the ICH score,the incidence and mortality of SAP were analyzed;the occurrence of SAP was prejudged by ICH score.The ROC curve was plotted,and the sensitivity,specificity and the best cut-off value were calculated. Results (1) The incidence of SAP was 34.9% (73/209) and the mortality was 21.1% (44/209) in patients with ICH.(2) There were significant differences in age (73 ± 12 and 63 ± 14),hematoma volume (23.4 [9.6,51.1] and 6.2 [3.1,16.0],and ICH score (2[1,3] and 1 [0,2]) between the SAP group and the non-SAP group (all P<0.01).Compared with non-SAP group,Glasgow coma scale(GCS) score of the SAP group was significantly decreased(8 [4,11] and 15 [13,15],P<0.01).The area under the ROC curve of the ICH score predicting the occurrence of SAP was 0.775 (95% CI 0.709-0.842,P<0.01).When the maximum Youden index was 0.453,the best cut-off value of the corresponding ICH score was 2,its sensitivity was 74%,specificity was 71%,the positive predictive value was 0.58,and the negative predictive value was 0.84. Conclusions The incidence of SAP in patients with ICH is higher.The ICH score may predict the clinical value of the occurrence of SAP. Clinical attention should be paid to the risk of occurring SAP in patients with ICH whose ICH score≥2.
RÉSUMÉ
OBJECTIVE:To observe therapeutic efficacy and safety of cefoperazone sodium and sulbactam sodium combined with Shenmai injection in the treatment of elderly stroke associated pneumonia(SAP). METHODS:A total of 84 SAP patients in Dazhou Municipal Central Hospital during Mar. 2016-Mar. 2017 were divided into control group(42 cases)and observation group (42 cases)according to random number table. Based on routine treatment,control group was additionally given Cefoperazone sodium and sulbactam sodium for injection 3 g added into 5% Glucose injection 100 mL,intravenously,twice a day;suitable antibiotics were selected according to the results of pathogenic examination and drug sensitivity test. Observation group was additionally given Shenmai injection 100 mL added into 5% Glucose injection 250 mL intravenously,once a day,on the basis of control group. Both groups were treated for consecutive 2 weeks. Clinical efficacies of 2 groups were observed,and the levels of T-lymphocyte subsets(CD4+,CD8+,CD4+/CD8+)and inflammatory markers(TNF-α,hs-CRP,PCT),length of hospital stay before and after treatment. The ADR was recorded. RESULTS:The total response rate(95.24%)and marked response rate (47.62%)of observation group were significantly higher than those of control group(83.33%,23.81%);length of hospital stay in observation group [(15.24±3.53)d] was significantly shorter than control group [(18.43±4.21)d],with statistical significance (P<0.05).After treatment,the levels of CD4+and CD4+/CD8+in 2 groups were significantly higher than before treatment,and the observation group was significantly higher than the control group;the levels of CD8 +,TNF-α,hs-CRP and PCT in 2 groups were significantly lower than before treatment;the observation group was significantly lower than the control group,with statistical significance(P<0.05);there was no statistical significance in the incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:Based on routine treatment,cefoperazone sodium and sulbactam sodium combined with Shenmai injection treat SAP significantly,can effectively improve immune function, reduce inflammation level and shorten the length of hospital stay without increasing the occurrence of ADR.