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Objective To explore the relationship between glycemic instability index (GLI), peripheral blood CD4+/ CD8+, neutrophil-to-lymphocyte ratio (NLR), red blood cell distribution width (RDW), neutrophil gelatinase-associated lipocalin (NGAL), and the occurrence, condition and prognosis of stroke-associated pneumonia (SAP). Methods According to the occurrence of SAP within 7 d after onset, 550 patients with acute cerebral infarction were divided into the study group (129 cases with SAP) and the control group (421 cases without SAP). GLI, peripheral blood CD4+ /CD8+, NLR, RDW and NGAL levels were measured. The differences in the above indicators were compared between the study group and the control group, as well as SAP patients with different conditions and prognoses. The relationship between above indicators and the occurrence, condition and prognosis of SAP was discussed. The prognostic values of each indicator and combination of indicators were analyzed. Results GLI, NLR, RDW and NGAL levels were higher in the study group, the medium to high risk group and the poor prognosis group than those in the control group, the low-risk group and the good prognosis group. CD4+/CD8+ was lower than that in the corresponding group (P＜0.05). Multivariate Logistic regression analysis showed that higher GLI and NLR were independent risk factors for acute cerebral infarction complicated with SAP, and higher GLI, NLR, RDW and NGAL were independent risk factors for the medium to high risk conditions in SAP patients, while higher levels of CD4+ /CD8+ were protective factor for high-risk diseases in patients with concurrent SAP and SAP (P＜0.05). Higher GLI, NLR and RDW were independent risk factors for poor prognosis in patients with SAP (P＜0.05). ROC curves indicated that the AUC of the combination of GLI, NLR and RDW for evaluating poor prognosis in patients with SAP was better than that of GLI or RDW. Conclusion Changes in GLI, CD4+ /CD8+ and NLR are influencing factors for the occurrence of SAP. GLI, CD4+ /CD8+, NLR, RDW and NGAL are influencing factors for the severity of SAP patients. GLI, NLR and RDW are associated with poor prognosis in SAP patients, and all three have certain predictive effective in predicting the prognosis of SAP patients, and NLR has the highest predictive efficacy. [ABSTRACT FROM AUTHOR]

Objective To analyze the predictive value of the age, atrial fibrillation, dysphagia, male sex, and National Institutes of Health Stroke Scale (A²DS²) score and serum inflammatory factors in stroke associated pneumonia (SAP) and its pathogenic bacteria. Methods From July 2022 to September 2023, 205 patients with acute stroke were included in the study. Patients with SAP were included in the SAP group (n=57), and the rest were in the non SAP group (n=148). The A'DS² scores of the patients were recorded; the serum levels of tumor necrosis factor - a (TNF - α), interleukin-2 (IL-2), IL-6, and IL-10 were analyzed by enzyme related immunosorbent assay; and sputum was detected in SAP patients. Results Patients in SAP group had significantly higher levels of IL-2, IL-6, IL-10, TNF-a and A2DS2 score (P<0.05). After adjusting for other relevant factors, the scores of IL-2, IL-6, IL-10 and A²DS² were still independent relevant factors for SAP. The A²DS² score combined with IL-2, IL-6 and IL - 10 predicted SAP significantly better than the four predictions alone, with area under receiver operating characteristic curve of 0.891 (95% confidence interval: 0.847-0.936), sensitivity and specificity of 84.2% and 77.7%, respectively. A total of 61 strains were cultured, and 14 Gram positive bacteria, 44 Gram-negative bacteria and 3 fungi were detected. The IL-6 and IL-10 of SAP patients infected with Gram-negative bacteria were significantly higher (P<0.05). Conclusion IL-2, IL-6 and IL10 inflammatory factors combined with A²DS² scores may help to predict SAP in patients with acute stroke, and predict the type of pathogenic bacteria of SAP according to the levels of IL-6 and IL-10. [ABSTRACT FROM AUTHOR]

Objective To investigate the relationship between high-sensitivity C-reactive protein-albumin ratio(HCAR), acute ischemic stroke(AIS) associated pneumonia(SAP) and early clinical outcomes. Methods A total of 495 AIS who received treatment in the hospital from February 2021 to December 2022 patients with AIS were enrolled. All patients were divided into the SAP group and the non-SAP group according to whether SAP occurred during hospitalization. The patients were divided into four groups according to the quartile of HCAR level at admission[Q1 group(≤1. 3), Q2 group(1. 3-3. 7), Q3 group(3. 9-9. 2), Q4 group (≥9. 3)]. Baseline data at admission, data at discharge and 3-month follow-up data of all patients were collected. Univariate and multivariate logistic regression analysis were used to investigate the relationship between HCAR quartiles and SAP risk, 3-month adverse outcomes and 3-month all-cause mortality. Receiver-operating characteristic(ROC) curve was used to evaluate the predictive value of HCAR and other related indicators for SAP. Results SIP was diagnosed in 68(18. 6%) AIS patients during hospitalization, and the HCAR in the SAP group was significantly higher than that in the non-SAP group, the differences wase statistically significant( P <0. 001). In the unadjusted model, the incidence of SAP in Q2 group, Q3 group and Q4 group was significantly higher than that in the Q1 group(P <0. 05, Ptrend <0. 001). In the adjusted model, the incidence of SAP in Q2 group, Q3 group and Q4 group was also higher than that in Q1 group, and the incidence of SAP in Q3 group and Q4 group was significantly higher than that in Q1 group(P <0. 05, Ptrend <0. 001). ROC curve analysis showed that the AUC of HCAR was the largest, and the AUC of HCAR was significantly different from that of high-sensitivity C-reactive protein(hs-CRP) or albumin(Alb)(P <0. 05). There was no significant difference in AUC between HCAR and A2DS2 score(P >0. 05), but HCAR(sensitivity and specificity were 77. 17% and 73. 44%, respectively) had a more balanced sensitivity and specificity than A2DS2 score(sensitivity and specificity were 58. 72% and 83. 19%, respectively). HCAR at the Q4 level was significantly associated with adverse clinical outcomes(adjusted OR:Q4 vs. Q1 was 1. 98, Ptrend=0. 013). Patients with HCAR above Q3 had a higher risk of death within three months(adjusted OR:Q3 vs. Q1 was 2. 63, Q4 vs. Q1 was 3. 75, Ptrend=0. 001). Conclusion AIS patients with high HCAR levels at admission are more likely to develop SAP during hospitalization, and their early clinical outcomes are relatively worse. The incidence of adverse outcome and mortality rate at three months are higher. [ABSTRACT FROM AUTHOR]

目的 探讨高分级动脉瘤性蛛网膜下腔出血患者术后肺炎病原学特点和其耐药性，为抗菌药物的合理使用提供参考依据。 方法 回顾性分析2013年10月—2020年12月手术治疗的Hunt-Hess Ⅳ～Ⅴ级动脉瘤性蛛网膜下腔出血患者的临床资料，分析痰培养病原菌情况及抗菌药物敏感试验结果。 结果 共纳入183例患者，均有肺部感染，其中122例（66.7%）行气管切开治疗。有451份痰培养标本，其中284份（63.0%）痰培养标本为阳性，检出病原菌305株，其中革兰阴性菌229株（75.1%）、革兰阳性菌38株（12.5%）、真菌38株（12.5%），未发现厌氧菌，混合感染有21份（7.4%）。183例肺部感染患者中痰培养病原菌改变者44例（24.0%）。革兰阴性菌主要是肺炎克雷伯杆菌（32.8%）、鲍曼不动杆菌（16.2%）、铜绿假单胞菌（14.4%）和大肠杆菌（12.7%），其中肺炎克雷伯杆菌和鲍曼不动杆菌产超广谱β-内酰胺酶菌株的比例分别为36.0%、51.4%；药敏试验结果显示其对亚胺培南、哌拉西林/他唑巴坦、妥布霉素、替加环素敏感性高。革兰阳性菌主要是金黄色葡萄球菌属（92.1%），其中耐甲氧西林金黄色葡萄球菌的比例为48.6%；药敏试验结果显示其对万古霉素、利奈唑胺和利福平敏感性高。真菌主要是白色念珠菌（39.5%），对抗真菌药物均敏感。 结论 高分级动脉瘤性蛛网膜下腔出血患者术后肺部感染率高，以革兰阴性菌为主，耐药性强，应根据其病原学特点和药敏试验结果合理选用抗菌药物。 Abstract: Objective To investigate the etiology characteristics and drug resistance of post-microsurgery pneumonia in patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH), to provide reference for rational use of antibiotics. Methods The clinical data of patients with Hunt-Hess Ⅳ-Ⅴ aSAH who received microsurgery treatment were retrospectively analyzed, to analyze the sputum culture pathogens and antimicrobial susceptibility test (AST). Results A total of 183 cases were included in this study, and they all had lung infection and 122 cases (66.7%) received tracheotomy. Of 451 sputum specimens, 284 (63.0%) were positive. 305 strains of bacteria were isolated from positive specimens, including 229 strains (75.1%) of Gramnegative bacteria, 38 strains (12.5%) of Gram-positive bacteria, 38 strains (12.5%) of fungi, and no anaerobic bacterium was found. The mixed infection occurred in 21 specimens (7.4%). Sputum culture bacteria changed in 44 cases (24.0%). The Gram-negative bacteria were mainly Klebsiella pneumoniae (32.8%), Acinetobacter baumannii (16.2%), pseudomonas aeruginosa (14.4%) and escherichia coli (12.7%). The ratio of Klebsiella pneumoniae and Acinetobacter banmannii producing the extended spectrum β-lactamases (ESBLs) strains was 36.0% and 51.4%, respectively; and the AST showed that most of the strains were sensitive to imipenem, piperacillin and tazobactam, tobramycin, and tegacyclin. The Gram-positive bacteria were mainly Staphylococcus aureus (92.1%), of which the proportion of Methicillin-resistant Staphylococcus aureus (MRSA) were 48.6%; and the AST showed that the strains were sensitive to vancomycin, linezolid and Li Fuping. Fungi was mainly Candida albicans (39.5%), and they were sensitive to antifungal drugs. Conclusions The patients with poor-grade aSAH had high risk of post-microsurgery pneumonia; and the pathogens were mainly Gram-negative bacteria, and they had strong drug resistance.

Objective To investigate the effect of mechanical vibration sputum expectoration in the adjuvant treatment of stroke-associated pneumonia. Methods Totally 60 patients with stroke-associated pneumonia were divided into control group (n=30)and study group(n=30) according to the arrival sequences of hospital admission. All patients received anti-infective therapy for stroke-associated pneumonia. The routine hand-assisted percussion on the back was adopted in the control group, while the mechanical vibration sputum expectoration was carried out in the study group. The clinical symptoms and clinical pulmonary infection scores of the two groups were observed at one week after intervention. Results The overall response rate of treatment was 96. 67%(29/30)in the study group, which was higher than 80. 00%(24/30)in the control group (P＜0. 05). Patients in the study group had a higher volume of sputum expectoration and shorter time to moist rale disappear compared with those in the control group (P＜0. 01). Patients in the study group achieved better outcomes of respiratory rate, SaO 2 and PaO 2 compared with those in the control group (P＜0. 01). Conclusion Application of mechanical vibration sputum expectoration is potentially effective to improve the condition of patients and enhance the treatment efficacy of stroke-associated pneumonia. (目的 探讨机械振动排痰辅助治疗卒中相关性肺炎的效果。方法 选取2019年 2 月—2020 年 8 月医院收治的脑卒中患者60例为研究对象, 均确诊卒中相关性肺炎。按患者入院时间顺序分为对照组和研究组, 各30例。2组患者均接受基础抗感染治疗, 对照组给予传统人工叩背手段排痰, 研究组给予机械振动排痰。1周后观察2组患者的临床症状和临床肺部感染评分。结果 研究组总有效率96. 67%(29/30), 高于对照组的80. 00%(24/30), 差异有统计学意义(P＜0. 05)。研究组排痰量多于对照组, 肺部湿啰音消失时间短于对照组, 差异有统计学意义(P＜0. 01)。研究组呼吸频率、血氧饱和度(SaO 2 )、动脉血氧分压(PaO 2 )改善幅度优于对照组, 差异有统计学意义(P＜0. 01)结论 运用机械振动排痰辅助治疗可以改善卒中相关性肺炎善患者肺部感染病情, 提高治疗效果。)

Objective To observe the effect of diet intervention with food thickener in prevention of stroke-associated pneumonia (SAP) and relief of dysphagia. Methods Totally 180 patients with dysphagia after stroke were randomly divided into the observation group and control group, with 90 cases in each group. All patients received routine care and rehabilitation training, and those in the observation group were given systematic diet intervention with food thickener. The incidences of SAP and aspiration were observed, and the recovery of swallowing function was evaluated by Water Swallow Test. Results The incidence of aspiration in the observation group was lower than that in the control group (P＜0. 05). The incidence of dysphagia in the observation group was lower than that in the control group (P＜0. 05). There was no significant difference in rate of swallowing function recovery between two groups (P＜0. 05). Conclusion The diet intervention with food thickener is effective to reduce the risk of aspiration, showing a positive role in prevention of SAP. (目的 观察食品增稠剂预防卒中相关性肺炎及改善吞咽困难的临床效果。方法 将180例脑卒中吞咽困难患者随机分为观察组和对照组, 各90例。对照组给予常规护理和康复训练, 观察组在常规护理的基础上行系统性食品增稠剂饮食训练。干预后观察并记录患者卒中相关性肺炎的发生情况, 根据洼田饮水试验对患者吞咽障碍恢复效果进行评价。结果 观察组患者误吸发生率低于对照组, 差异有统计学意义(P＜0. 05); 观察14 d后, 观察组卒中相关性肺炎发生率低于对照组, 差异有统计学意义(P＜0. 05)。两组吞咽功能好转率比较, 差异无统计学意义(P＞0. 05)。结论 通过食品增稠剂的应用可以明显减少呛咳、噎食的发生, 从而降低误吸的发生风险, 对卒中相关性肺炎起到积极的预防效果。)

To analyze the clinical characteristics of acute cerebral infarction with dysphagia and the influencing factors of stroke associated pneumonia (SAP). Methods: 190 patients with acute cerebral infarction who were treated in our hospital from October 2019 to October 2021 were selected as the research objects. According to the score of Watian drinking water test, they were divided into good swallowing group (98 cases) and dysphagia group (92 cases). The clinical data of the two groups were compared, the clinical characteristics of patients with acute cerebral infarction with dysphagia were explored. The incidence of SAP in 92 patients with dysphagia group onset period was counted, and the patients were divided into SAP group and non SAP group. The basic data and clinical data of the two groups were compared and analyzed, and the risk factors of SAP in patients with acute cerebral infarction with dysphagia were discussed by univariate analysis and multivariate Logistic regression analysis. Results: There were no significant differences in gender, body mass index(BMI), smoking history, drinking history and basic disease history between dysphagia group and good swallowing group(P>0.05), but the age, National Institutes of health neurological deficit score (NIHSS), infarct size, brain stem ratio of infarct site in dysphagia group were higher than those in good swallowing group(P<0.05). SAP occurred in 34 of 92 patients with acute cerebral infarction with dysphagia, with an incidence of 36.96%. Univariate analysis showed that there were no significant differences in the gender, BMI, drinking history, history of hypertension and history of hyperlipidemia between SAP group and non-SAP group (P>0.05), while the age, NIHSS score, smoking history ratio and diabetes history proportion in SAP group were higher than those in non-SAP group (P<0.05). Logistic regression analysis showed that advanced age, high NIHSS score, smoking history and diabetes history were independent risk factors for acute cerebral infarction with dysphagia complicated with SAP (P<0.05, OR > 1). Conclusion: In elderly patients with acute cerebral infarction, severe neurological deficits, large infarct size and brainstem infarction patients are prone to swallowing dysfunction, and some patients will develop SAP. Older age, high NIHSS score, smoking history and diabetes history are the influencing factors of SAP in-duction, which deserve clinical attention. [ABSTRACT FROM AUTHOR]

Objective To study the risk factors and pathogens of stroke-associated pneumonia (SAP) multi-drug resistant bacteria (MDR) infection, so as to identify SAP as soon as possible and take preventive measures. Methods From June 2016 to December 2018, 680 elderly stroke patients in the neurological disease center of the hospital were selected, of which 156 were SAP patients. The clinical data of patients were retrospectively analyzed, single-factor and multi-factor analysis of risk factors for MDR infection were conducted, and pathogenic bacteria were analyzed. Results Among 156 SAP patients, 69 had MDR infection, and the infection rate was 44.2%. MDR infection was related to age, stroke type, level of consciousness, coronary heart disease, history of chronic lung disease,dysphagia,indwelling gastric tube, tracheal intubation,and preventive use of antibiotics (P <0.05). MDR infection was not related to gender, smoking history, diabetes, hypertension, intravenous thrombolysis (P>0.05). A total of 47 pathogens were isolated from patients with MDR infection, including 27 Gram-negative bacteria (57.4%) and 15 Gram-positive bacteria (31.9%). Conclusion Age, stroke type, level of consciousness, coronary heart disease, history of chronic lung disease, combined dysphagia, indwelling gastric tube, tracheal intubation, and preventive use of antibiotics are risk factors for MDR infection in elderly SAP patients.The pathogenic bacteria are mainly Gram-negative bacteria. [ABSTRACT FROM AUTHOR]

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Objective: To investigate the clinical efficacy of ulinastatin in the treatment of severe stroke associated pneumonia and its effect on serum inflammatory factors. Methods: 96 cases of patients with severe stroke associated pneumonia in our hospital from January 2015 to June 2017 were selected and randomlydivided into three groups. The control group was treated with mechanical ventilation,anti infection, expectorant, nutritional support, fluid replacement and other conventional treatment. The observation group A(low-dose group) was given intravenous injection of ulinastatin(0.3 million U/Kg, 8 h) on the basis of routine treatment. The observation group B(high-dose group) was given intravenous injection of ulinastatin(1.2 million U/Kg, 8 h) on the basis of routine treatment. Both groups were treated continuously for 7 days after admission. The hospitalization time, relief time of cough, recovery time of body temperature,rales disappearance time, changes of the serum interleukin-6, tumor necrosis factor-alpha and high mobility group box-1(HMGB1) levels before and after treatment were compared among three groups. Results: After treatment, the effective rate of observation group A and B were 91.67 % and 95.84%, which were significantly higher than that of the control group 70.83 %(P<0.05). The hospitalization time, relief time of cough, recovery time of body temperature, rales disappearance time of observation group A and B were significantly shorter than those in the control group(P<0.05). The levels of interleukin-6, tumor necrosis factor alpha and interleukin-23 in the observation A and B groups were significantly lower than those in the control group after the treatment(P<0.05). The levels of interleukin-6, tumor necrosis factor alpha and interleukin-23 in the observation group B were significantly lower than those in the observation A after the treatment(P<0.05). Conclusions: Ulinastatin can accelerate the recovery of patients with stroke-associated pneumonia, which may be related to the decrease of serum inflammatory cytokines IL-6, TNF-α and HMGB-1. [ABSTRACT FROM AUTHOR]

目的 观察纤维支气管镜吸痰辅助治疗老年卒中相关性肺炎的效果。方法 152例老年卒中相关性肺 炎患者，其中采用吸痰管吸痰86例（常规组）、纤维支气管镜吸痰66例（干预组）。比较两组痰培养阳性率、临床疗 效、住院时间、住院费用及不良反应发生情况。结果与常规组相比.丨预组痰培养阳性率高、临床总有效率高、住 院时间短、住院费用少(P均<0.05)。两组治疗过程中均未出现明显咯血、气道痉挛及严重心律失常等不良反应。 结论纤维支气管镜吸痰辅助治疗老年卒中相关性肺炎疗效较好，可以缩短住院时间、减少住院费用，且无严重不 良反应。 [ABSTRACT FROM AUTHOR]