1. Department of Neurology, Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai 200137, China; 2. Department of Neurorehabilitation, Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai 200137, China
Pneumonia is one of the most common complications of stroke. Understanding of the pathogenesis, clinical manifestations, laboratory and imaging findings and the risk factors related to stroke-associated pneumonia may contribute to the early identification of high-risk patients and taking strategies for prevention in early-stage after the onset of stroke, so as to reduce the incidence rate of stroke-associated pneumonia. Early identification of stroke-associated pneumonia and effective treatment can improve the success rate of treatment in patients with stroke. This paper summarizes the pathogenesis, diagnostic criteria, pathogen characteristics, risk assessment and prediction, and prevention measures of stroke-associated pneumonia in recent years, in order to provide clinical guidance on diagnosis, prevention and treatment of stroke-associated pneumonia.
WANG Qinying, ZHAN Qing.
Advances in stroke-associated pneumonia[J]. Journal of Neurology and Neurorehabilitation. 2016, 12(1): 29-35 https://doi.org/10.12022/jnnr.2016-0019
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参考文献
[1] KUMAR S, SELIM M H, CAPLAN L R. Medical complications after stroke[J]. Lancet Neurol, 2010, 9(1):105-118. [2] HILKER R, POETTER C, FINDEISEN N, et al. Nosocomial pneumonia after acute stroke: implications for neurological intensive care medicine[J]. Stroke, 2003, 34(4):975-981. [3] SMITH C J, KISHORE A K, VAIL A, et al. Diagnosis of stroke-associated pneumonia: recommendations from the pneumonia in stroke consensus group[J]. Stroke, 2015, 46(8):2335-2340. [4] DZIEWAS R, RITTER M, SCHILLING M, et al. Pneumonia in acute stroke patients fed by nasogastric tube[J]. J Neurol Neurosurg Psychiatry, 2004, 75(6):852-856. [5] HANNAWI Y, HANNAWI B, RAO C P, et al. Stroke-associated pneumonia: major advances and obstacles[J]. Cerebrovasc Dis, 2013, 35(5):430-443. [6] SUI R, ZHANG L. Risk factors of stroke-associated pneumonia in Chinese patients[J]. Neurol Res, 2011, 33(5):508-513. [7] JI R, SHEN H, PAN Y, et al. Novel risk score to predict pneumonia after acute ischemic stroke[J]. Stroke, 2013, 44(5):1303-1309. [8] LI L, ZHANG L H, XU W P, et al. Risk assessment of ischemic stroke associated pneumonia[J]. World J Emerg Med, 2014, 5(3):209-213. [9] LI Y, SONG B, FANG H, et al. Validation of the A(2)DS(2) score to predict stroke-associated pneumonia in a Chinese population: A prospective cohort study[J]. PLoS One, 2014, 9(10):e109665. [10] HOFFMANN S, MALZAHN U, HARMS H, et al. Development of a clinical score (A 2 DS 2 ) to predict pneumonia in acute ischemic stroke[J]. Stroke, 2012, 43(10):2617-2623. [11] SMITH C J, BRAY B D, HOFFMAN A, et al. Can a novel clinical risk score improve pneumonia prediction in acute stroke care? A UK multicenter cohort study[J]. J Am Heart Assoc, 2015, 4(1):e001307. [12] GARNER J S, JARVIS W R, EMORI T G, et al. CDC definitions for nosocomial infections, 1988[J]. Am J Infect Control, 1988, 16(3):128-140. [13] BUSTI C, AGNELLI G, DURANTI M, et al. Lung ultrasound in the diagnosis of stroke-associated pneumonia[J]. Intern Emerg Med, 2014, 9(2):173-178. [14] HASSAN A, KHEALANI B A, SHAFQAT S, et al. Stroke-associated pneumonia: microbiological data and outcome[J]. Singapore Med J, 2006, 47(3):204-207. [15] HARMS H, GRITTNER U, DRÖGE H, et al. Predicting post-stroke pneumonia: the PANTHERIS score[J]. Acta Neurol Scand, 2013, 128(3):178-184. [16] WALTER U, KNOBLICH R, STEINHAGEN V, et al. Predictors of pneumonia in acute stroke patients admitted to a neurological intensive care unit[J]. J Neurol, 2007, 254(10):1323-1329. [17] HUG A, MÜRLE B, DALPKE A, et al. Usefulness of serum procalcitonin levels for the early diagnosis of stroke-associated respiratory tract infections[J]. Neurocrit Care, 2011, 14(3):416-422. [18] FLURI F, MORGENTHALER N G, MUELLER B, et al. Copeptin, procalcitonin and routine inflammatory markers-predictors of infection after stroke[J]. PLoS One, 2012, 7(10):e48309. [19] ZHANG X, WANG F, ZHANG Y, et al. Risk factors for developing pneumonia in patients with diabetes mellitus following acute ischaemic stroke[J]. J Int Med Res, 2012, 40(5):1860-1865. [20] ZHAO H, LIN G, SHI M, et al. The mechanism of neurogenic pulmonary edema in epilepsy[J]. J Physiol Sci, 2014, 64(1):65-72. [21] HARMS H, HOFFMANN S, MALZAHN U, et al. Decision-making in the diagnosis and treatment of stroke-associated pneumonia[J]. J Neurol Neurosurg Psychiatry, 2012, 83(12):1225-1230. [22] GOSNEY M A, MARTIN M V, WRIGHT A E, et al. Enterobacter sakazakii in the mouths of stroke patients and its association with aspiration pneumonia[J]. Eur J Intern Med, 2006, 17(3):185-188. [23] FRANK D N, FEAZEL L M, BESSESEN M T, et al. The human nasal microbiota and Staphylococcus aureus carriage[J]. PLoS One, 2010, 5(5):e10598. [24] TONG X, KUKLINA E V, GILLESPIE C, et al. Medical complications among hospitalizations for ischemic stroke in the United States from 1998 to 2007[J]. Stroke, 2010, 41(5):980-986. [25] KATZAN I L, CEBUL R D, HUSAK S H, et al. The effect of pneumonia on mortality among patients hospitalized for acute stroke[J]. Neurology, 2003, 60(4):620-625. [26] KATZAN I L, DAWSON N V, THOMAS C L, et al. The cost of pneumonia after acute stroke[J]. Neurology, 2007, 68(22):1938-1943. [27] CHUMBLER N R, WILLIAMS L S, WELLS C K, et al. Derivation and validation of a clinical system for predicting pneumonia in acute stroke[J]. Neuroepidemiology, 2010, 34(4):193-199. [28] DIRNAGL U, KLEHMET J, BRAUN J S, et al. Stroke-induced immunodepression: experimental evidence and clinical relevance[J]. Stroke, 2007, 38:(2 Suppl)770-773. [29] MARTINO R, FOLEY N, BHOGAL S, et al. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications[J]. Stroke, 2005, 36(12):2756-2763. [30] DZIEDZIC T, PERA J, KLIMKOWICZ A, et al. Serum albumin level and nosocomial pneumonia in stroke patients[J]. Eur J Neurol, 2006, 13(3):299-301. [31] LIM S H, LIEU P K, PHUA S Y, et al. Accuracy of bedside clinical methods compared with fiberoptic endoscopic examination of swallowing (FEES) in determining the risk of aspiration in acute stroke patients[J]. Dysphagia, 2001, 16(1):1-6. [32] HONG K S, KANG D W, KOO J S, et al. Impact of neurological and medical complications on 3-month outcomes in acute ischaemic stroke[J]. Eur J Neurol, 2008, 15(12):1324-1331. [33] 卒中相关性肺炎诊治中国专家共识[J]. 中华内科杂志, 2010, 49(12):1075-1078. [34] HINCHEY J A, SHEPHARD T, FURIE K, et al. Formal dysphagia screening protocols prevent pneumonia[J]. Stroke, 2005, 36(9):1972-1976. [35] ODDERSON I R, KEATON J C, MCKENNA B S. Swallow management in patients on an acute stroke pathway: quality is cost effective[J]. Arch Phys Med Rehabil, 1995, 76(12):1130-1133. [36] DOGGETT D L, TAPPE K A, MITCHELL M D, et al. Prevention of pneumonia in elderly stroke patients by systematic diagnosis and treatment of dysphagia: an evidence-based comprehensive analysis of the literature[J]. Dysphagia, 2001, 16(4):279-295. [37] GOSNEY M, MARTIN M V, WRIGHT A E. The role of selective decontamination of the digestive tract in acute stroke[J]. Age Ageing, 2006, 35(1):42-47. [38] HUANG J Y, ZHANG D Y, YAO Y, et al. Training in swallowing prevents aspiration pneumonia in stroke patients with dysphagia[J]. J Int Med Res, 2006, 34(3):303-306. [39] PRASS K, MEISEL C, HÖFLICH C, et al. Stroke-induced immunodeficiency promotes spontaneous bacterial infections and is mediated by sympathetic activation reversal by poststroke T helper cell type 1-like immunostimulation[J]. J Exp Med, 2003, 198(5):725-736. [40] LACKLAND D T, ROCCELLA E J, DEUTSCH A F, et al. Factors influencing the decline in stroke mortality: a statement from the American Heart Association/American Stroke Association[J]. Stroke, 2014, 45(1):315-353.