摘要目的 探讨咽喉镜下吸痰对缺血性卒中相关性肺炎发生及预后的影响.方法 选择127例急性缺血性脑卒中(acute ischemic stroke,AIS)且格拉斯哥昏迷评分6～12分、非人工气道的患者,分为咽喉镜直视下吸痰操作组(n=59),及常规经口、鼻腔吸痰的对照组(n=68),前者为前瞻性研究病例,后者为回顾性分析病例.在ICU住院期间,纳入病例均予常规翻身拍背、物理振动排痰及化痰药物等措施,比较2组患者的卒中相关性肺炎(stroke-associated pneumonia,SAP)发病率及28 d病死率,及其炎性标志物(白细胞计数、超敏C反应蛋白、降钙素原)的演变趋势和操作组相关意外事件的发生率.结果 操作组与对照组比较,SAP发生率(32.20％ vs.41.18％,P＞0.05)、28d病死率(47.37％ vs.53.57％,P＞0.05)差异均无统计学意义;但ICU住院时间、炎性标志物等方面差异具有统计学意义(P＜0.05),并且需要人工气道、有创机械通气的发生率减少(18.64％ vs.35.29,P＜0.05),咽喉镜下吸痰对于SAP死亡或需建立人工气道、机械通气的发生是保护性因素(HR=0.515;95％ CI,0.281 ～0.057,P=0.038);操作组中患者的血白细胞计数与降钙素原较对照组下降,差异具有统计学意义(P＜0.05).结论 咽喉镜下吸痰可减少AIS患者建立人工气道、使用有创呼吸机概率,缩短ICU住院时间,并降低血白细胞、降钙素原水平.

abstractsObjective To investigate the impact of sputum suction under laryngoscope in stroke patients on the occurrence and prognosis of ischemic stroke-associated pneumonia (SAP).Methods A total of 127 cases with acute ischemic stroke (AIS) with Glasgow Coma Scale 6-12 scores,non-artificial airway and need for intensive care were enrolled.According to the suction practice,the cases were divided into laryngoscope euthyphoria group (practice group,PG,n =59),and conventional oral or nasal sputum suction group (control group,CG,n =68).The PG was perspectively studied,while the CG were analyzed retrospectively.All patients were cared with the Guidelines for the management of adult with hospitalacquired ventilator-associated and healthcare-associated pneumonia set by American Thoracic Society/Infectious Diseases Society of America in 2005 and the Guidelines for the early management of patients with acute ischemic stroke set by American Heart Association/American Stroke Association in 2013 including patting on the back of patients in prone position routinely in order to facilitating expectoration,phlegm elimination with physical vibration and apophlegmatic agent application during their stay in ICU.Incidences of SAP and 28-day mortality were calculated.Levels of inflammatory markers (white blood cell,WBC;highsensitive C-reaction protein;procalcitonin,PCT) in serum were detected.Adverse events related to laryngoscopy were documented.Results There were no significant differences in incidences of SAP and 28-day mortality between PG and CG groups (32.20％ vs.41.18％,P ＞ 0.05;47.37％ vs.53.57,P ＞ 0.05,respectively).However,there was statistically significant difference (P ＜ 0.05) in the ICU stay length and inflammatory markers,and the sputum suction process in PG did decrease the incidence of artificial airway establishment and mechanical ventilation (18.64％ vs.35.29％,P ＜ 0.05),and the laryngoscope euthyphoria method was proved to be a protective factor (HR =0.515;95％ CI 0.281-0.057,P =0.038).WBC and PCT were lower in PG group than in CG group (P ＜ 0.05).Conclusion Sputum suction under laryngoscope can reduce the probability of artificial airway establishment and invasive ventilator employment in patients with AIS,shortening ICU stay length and down-regulating levels of WBC and PCT.