Study On The Risk Factors Of Stroke-associated Pneumonia And Its Relationship With Dysphagia In Post-stroke Patients

Objective The purpose of this study was to analyze the risk factors of stroke-associated pneumonia(SAP)in stroke patients and explore the correlation between dysphagia and SAP through VFSS,and provide a scientific basis for future lung infections in stroke patients.Methods A retrospective research study was investigated 137 patients with stroke and dysphagia who had parallel VFSS examination in our hospital from October 2017 to December 2019.All study subjects were introduced to SAP group and non-SAP group according to SAP diagnostic criteria.Logistic multivariate regression analysis was used to determine the correlation between recessive aspiration.According to whether the patients were combined with aspiration and cough,the swallowing dysfunction was grouped: group 1 was the normal swallowing group;group 2 was the abnormal swallowing group without aspiration;group 3 was the abnormal swallowing group with dominant aspiration;The four groups were abnormal swallowing groups with hidden aspiration,to analyze the correlation between different types of dysphagia and SAP.Results This study included 137 patients with stroke and dysphagia who had undergone VFSS examination to assess the degree of dysphagia,about 86 patients with SAP,and the infection rate was 62.8%.Among them,98 were males and 39 were females,the average age was 61.57 ± 11.46 years,85 were ischemic strokes,the incidence was 52.9%,52 were cerebral hemorrhage,and the incidence was 78.8%.Univariate analysis showed that gender,stroke type,period of onset,indwelling gastric tube,gas-cut state,dysphagia,use of antacids,white blood cell count,neutrophil count,lymphocyte count,NLR and SAP were correlated.Unconditional logistic multivariate regression analysis showed that men,cerebral hemorrhage,swallowing dysfunction,use of antacids,and NLR were independent influencing factors of SAP.The area under the ROC curve of NLR was 77.5%(95% CI 0.691-0.858).When the NLR cutoff value was5.178,the sensitivity of predicting SAP in stroke patients with dysphagia was 76.7%,and the specificity was 76.5%.Among the different types of dysphagia,only incomplete opening of the circulatory pharyngeal muscle and latent aspiration are associated with SAP.At the same time,the stroke patients were divided into 4 groups according to whether they were combined with inhalation and cough.It was found that the difference in the incidence of SAP between the normal swallowing group and the three abnormal swallowing groups was statistically significant,and the incidence of SAP in the normal swallowing group was less than abnormal swallowing group,that is,when stroke patients with dysphagia,the incidence of SAP increased;there was no statistically significant difference between the abnormal swallowing group with no aspiration and the obvious aspiration group,but with the implicit aspiration The difference is statistically significant,indicating that when stroke patients with dysphagia have aspiration,but they have the ability to cough,that is,when the aspiration method is dominant aspiration,compared with patients without aspiration disorder,the incidence of SAP There is no obvious difference,and when the stroke aspiration of patients with stroke is recessive aspiration without cough reflex,the incidence of SAP is significantly increased;comparing the dominant aspiration group with the recessive aspiration group,you can It was found that there was a significant difference in the incidence of SAP between the two groups,that is,the probability of SAP in implicit aspiration was greater than that of explicit aspiration.Conclusion SAP is more closely related with Male,cerebral hemorrhage,dysphagia,use of antacids,and NLR.The increase of NLR within 24 hours of admission will increase the susceptibility of SAP.NLR> 5.178 has a certain predictive effect on SAP.The dysphagia grouping can predict the occurrence and development of SAP.Compared with patients with normal swallowing,the probability of SAP in patients with aspiration is significantly increased,and the risk of implicit aspiration is the greatest.