摘要
目的通过倾向性评分匹配方法,评估亚低温治疗对患者脑卒中后感染的影响及与预后的关系.方法回顾性分析2012年3月至2018年4月因脑卒中于广西医科大学第一附属医院重症医学科(ICU)、神经内科及神经外科住院治疗患者的临床资料.根据是否进行亚低温治疗将患者分为常规治疗组(NT组)和亚低温治疗组(MHT组);再将MHT组患者以1:1的比例运用倾向性评分匹配方法与NT组患者进行匹配.观察期为患者入院后7 d.分析匹配前队列和匹配后队列患者的基线特征〔年龄、性别、脑卒中类型、合并症、入院时急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、格拉斯哥昏迷评分(GCS)、外科手术、吞咽困难、侵入性操作〕以及临床结局.主要临床结局为卒中后感染发生率;次要临床结局包括:感染初发时间(TII,指脑卒中发病至感染发生的时间),住院病死率,出院时序贯器官衰竭评分(SOFA),心律失常、凝血功能障碍和多器官功能障碍综合征(MODS)等并发症发生率.结果共纳入201例脑卒中患者,其中41.8%(84/201)接受了亚低温治疗.匹配前,与NT组比较,MHT组男性患者较多(71.4%比56.4%),外科手术、机械通气、深静脉置管、胃管置管的比例更高(78.6%比54.7%,84.5%比39.3%,90.5%比37.6%,98.8%比70.9%),且有更高的感染发生率(90.5%比72.6%)和住院病死率(27.4%比12.8%),TII明显延长〔h:62.00(35.25,93.00)比42.00(28.50,69.50)〕,差异均有统计学意义(均P<0.05).MHT组有53例患者与HT组患者匹配成功,匹配后,MHT组与NT组间15项基线特征指标比较差异无统计学意义,且感染发生率和住院病死率的显著差异消失(92.5%比88.7%,22.6%比26.4%,均P>0.05),但MHT组较NT组有更长的TII〔h:62.00(40.75,92.25)比40.00(28.00,63.00),P=0.000〕.匹配前后,两组间出院SOFA评分及各并发症发生率差异均无统计学意义.结论亚低温治疗对患者卒中后感染发生率和住院病死率无显著影响,但可以延迟感染的发生,提供更大的治疗时间窗.
Objective To evaluate the effect of mild hypothermia on the incidence of post-stroke infection and explore the relationship between mild hypothermia and outcome of stroke patients by using propensity score matching.Methods Patients hospitalized in department of intensive care unit(ICU),neurology and neurosurgery in the First Affiliated Hospital of Guangxi Medical University due to stroke from March 2012 to April 2018 were retrospectively analyzed.According to whether or not mild hypothermia was provided,they were divided into the normal thermic group(NT group)and mild hypothermia treatment group(MHT group).The MHT group patients were matched with the NT group patients by the propensity score matching method at a ratio of 1:1.The observation period was within the first 7 days after admission.Baseline characteristics including age,gender,type of stroke,comorbidities,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score and Glasgow coma score(GCS)on admission,surgical operation,dysphagia,invasive procedures and outcomes of these patients had been analyzed.The primary outcome was incidence of post-stroke infection,and the secondary outcomes included the time of initial infection(TII,the duration from stroke to initial infection),hospital mortality,sequential organ failure assessment(SOFA)at discharge,incidence of complications such as arrhythmia,coagulation dysfunction and multiple organ dysfunction syndrome(MODS).Results 201 stroke patients were enrolled,41.8%(84/201)of whom underwent mild hypothermia.Comparison with NT group before matching,there were more males in MHT group(71.4%vs.56.4%),the proportion of surgical operation,mechanical ventilation,deep vein catheterization and gastric catheterization were higher(78.6%vs.54.7%,84.5%vs.39.3%,90.5%vs.37.6%,98.8%vs.70.9%),and so as incidence of infection(90.5%vs.72.6%),in-hospital mortality(27.4%vs.12.8%)and TII[hours:62.00(35.25,93.00)vs.42.00(28.50,69.50)].All the differences were statistically significant(all P<0.05).Fifty-three patients in the MHT group were matched with 53 patients in the NT group.After matching,there was no significant difference in 15 baseline characteristics between two groups.Significant differences in infection and hospital mortality between the MHT group and NT groups disappeared(92.5%vs.88.7%,22.6%vs.26.4%,both P>0.05),while TII of MHT group was longer than that of the NT group[hours:62.00(40.75,92.25)vs.40.00(28.00,63.00),P=0.000].There were no statistically significant differences in SOFA score or complications between the two groups either before or after matching.Conclusion Mild hypothermia had no significant effect on the incidence of post-stroke infection and hospital mortality,it could delay the occurrence of infection and provide longer duration of treatment.
作者
周南君
赖洁
蒋良艳
胡军涛
潘熠平
汤展宏
Zhou Nanjun;Lai Jie;Jiang Liangyan;Hu Juntao;Pan Yiping;Tang Zhanhong(Department of Critical Care Medicine,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,Guangxi Zhuang Autonomous Region,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2019年第12期1435-1439,共5页
Chinese Critical Care Medicine
基金
国家自然科学基金(81660313)
国家临床重点专科建设项目(2011-873)。
关键词
脑卒中
亚低温
卒中后感染
病死率
并发症
Stroke
Mild hypothermia
Post-stroke infection
Mortality
Complication
作者简介
通信作者:汤展宏,Email:tangzhanhong139@sina.com。
