High incidence of pneumonia in elderly patients with basal ganglia infarction.
High incidence of pneumonia in elderly patients with basal ganglia infarction.
复制标题
老年基底节梗死患者肺炎发病率高。
DOI：
10.1001/archinte.1997.00440240085013
复制
发表时间：
1997
影响因子：
--
通讯作者：
H. Sasaki
中科院分区：
文献类型：
--
作者：
T. Nakagawa;K. Sekizawa;H. Arai;R. Kikuchi;K. Manabe;H. Sasaki
背景
肺炎是脑梗塞患者死亡的主要原因。我们评估了住进长期护理机构的276名65岁或65岁以上的患者与肺炎相关的发病率。此外，我们还研究了白天和晚上的吞咽反射，并监测了睡眠中无声吸气的发生。
目标
目的：探讨脑梗塞部位与肺炎发生率之间的可能关系，并评价静息吸入术在肺炎发生发展中的作用。
方法
根据CT结果将4组患者分为4组：无梗死组(A组)；单侧基底节梗死组(B组)；双侧基底节梗死组(C组)；基底节外半球梗死组(D组)。肺炎的诊断标准是：(1)胸片上发现新的肺浸润物，(2)有一项或一项以上下列特征：咳嗽、体温高于37.8摄氏度或主观呼吸困难。在研究之前，对中风患者在发病后1年以上进行随访，并进行监测，以确定他们是否持续影响大脑半球结构。肺炎发生率的平均观察时间为22个月。为了研究吞咽反射和监测睡眠时无声吸入性呼吸的发生，从A组和C组中随机选择15例卧床或卧椅的患者，分别在下午1点和凌晨1点检查吞咽反射，并根据反应潜伏期进行评估，潜伏期从经鼻导管向咽部注入1mL蒸馏水到开始吞咽。用氯化铟-111作为放射性示踪剂贴在牙齿上检查睡眠中无声吸入物的发生率，并在第二天早上进行胸部扫描。
结果
肺炎发生率B组(27.4%)是A组(12.9%)的2.12倍，C组(47.0%)是A组(12.9%)的3.64倍。凌晨1点，B组(P<0.05)和C组(P<0.01)的反应潜伏期较A组延长B组(P<；.01)和C组(P<；.001)的阳性扫描百分率也高于A组。
结论
由于睡眠中频繁吸入，基底节卒中可能使这些患者易患肺炎。
BACKGROUND
Pneumonia is a major cause of death in patients with cerebral infarction. We assessed morbidity associated with pneumonia in 276 patients 65 years of age or older who were admitted to a long-term care facility. Furthermore, we studied the swallowing reflex during the day and at night and monitored the occurrence of silent aspiration during sleep.
OBJECTIVES
To examine the possible relationship between the location of cerebral hemispheric infarctions and the incidence of pneumonia and to evaluate the role of silent aspiration in the development of pneumonia.
METHODS
The incidence of pneumonia was analyzed in 4 groups of patients who were assigned to a group on the basis of the following computed tomographic findings: no infarct (group A); 1 or more unilateral basal ganglia infarcts (group B); bilateral basal ganglia infarcts (group C); and 1 or more cerebral hemispheric infarcts outside the basal ganglia (group D). Criteria for diagnosis of pneumonia were (1) a new pulmonary infiltrate seen on a chest radiograph and (2) 1 or more of the following features: cough, temperature greater than 37.8 degrees C, or subjective dyspnea. Before the study, the patients with stroke were followed up for more than 1 year after their ictus and were monitored to determine if they sustained affecting cerebral hemispheric structures. The average duration of observation for incidence of pneumonia was 22 months. To study the swallowing reflex and to monitor for the occurrence of silent aspiration during sleep, 15 of the patients who were confined to bed or chair were randomly selected from each of groups A through C. The swallowing reflex was examined at both 1 PM and 1 AM and was evaluated according to latency of response, which was timed from the injection of 1 mL of distilled water into the pharynx through a nasal catheter to the onset of swallowing. The incidence of silent aspiration during sleep was examined using indium-111 chloride as a radioactive tracer attached to the teeth, and scanning of the thorax was performed the next morning.
RESULTS
The incidence of pneumonia was 2.12 times higher in the patients of group B (27.4%; P < .01) and 3.64 times higher in the patients of group C (47.0%; P < .001) than in the patients of group A (12.9%). The latency of response was longer in the patients of groups B (P < .05) and C (P < .001) than in those of group A at 1 AM. The percentage of positive scans was also higher in the patients of groups B (P < .01) and C (P < .001) than in those of group A.
CONCLUSION
Basal ganglia strokes might predispose these patients to develop pneumonia owing to frequent aspiration during sleep.
DOI：
--
发表时间：
2008
期刊：
J Am Geriaty soc 56
影响因子：
--
作者：
Teramoto S;Sasaki H;et al
通讯作者：
et al