张丽　　叶健晓　　王燕飞

[摘要] 目的 探討EICU重症脑卒中患者发生误吸的相关因素分析。 方法 选择2019年1月至2020年4月在我院EICU治疗的重症脑卒中患者122例的临床资料进行分析。根据是否发生误吸分为误吸组48例与非误吸组74例。单因素及多因素分析影响患者发生误吸的相关因素。 结果  ①单因素分析结果显示，年龄>80岁，有卒中史，合并COPD，GCS评分≤12分，NIHSS评分>15分，咳嗽反射减弱或消失，吞咽功能障碍，胃残余量≥150 mL的患者误吸发生率较高（P<0.05）。②多因素分析结果显示，年龄、卒中病史、GCS≤12分、NIHSS评分>15分、咳嗽反射减弱或消失、吞咽功能障碍、胃残余量≥150 mL是影响EICU重症脑卒中患者误吸的独立危险因素（P<0.05）。结论 高龄、既往有卒中病史、患者病情等是影响EICU重症脑卒中患者误吸的独立危险因素。在临床工作中，对于有高危因素的患者应更佳重视预防误吸的发生，可采用更为安全有效的方式喂养，以预防误吸的发生。

[关键词] EICU;重症脑卒中;误吸;高危因素

[中图分类号] R743.3          [文献标识码] A          [文章编号] 1673-9701（2021）12-0020-04

Analysis of related factors of aspiration in patients with severe stroke in EICU

ZHANG Li1   YE Jianxiao1   WANG Yanfei2

1.Emergency Department， Lishui Municipal Central Hospital in Zhejiang Province， Lishui   323000， China; 2.Department of Neurology， Tongde Hospital of Zhejiang Province， Hangzhou   310012， China

[Abstract] Objective To explore the analysis of related factors of aspiration in patients with severe stroke in EICU. Methods The clinical data of 122 patients with severe stroke who were treated in EICU in our hospital from January 2019 to April 2020 were selected. According to whether aspiration occurred， 48 patients were classified as the aspiration group and 74 patients were classified as the non-aspiration group. Single-factor and multi-factor analyses of related factors of aspiration were conducted. Results ①Single-factor analysis showed that the incidence of aspiration was higher in patients aged over 80 years， with stroke history， COPD complication， GCS score≤12 points， NIHSS score>15 points， weakened or disappeared cough reflex， swallowing dysfunction， gastric residual volume≥150 ml（P<0.05）. ②Multi-factor analysis indicated that age， stroke history， GCS≤12 points， NIHSS score>15 points， weakened or disappeared cough reflex， swallowing dysfunction， and residual gastric volume≥150 mL were the independent risk factors for aspiration in patients with severe stroke in EICU（P<0.05）. Conclusion Old age， past stoke history， and patient condition are independent risk factors for aspiration in patients with severe stroke in EICU. In clinical work， physicians should pay more attention to patients with high-risk factors to prevent aspiration. A safer and more effective way of feeding can be adopted to prevent the occurrence of aspiration.

[Key words] EICU; Severe stroke; Aspiration; High-risk factors

误吸是指进食或非进食时，在吞咽过程中有数不一的食物、口腔内分泌物或胃食管反流物等进入声门以下的气道，而不是全部随吞咽动作顺利进入食管。误吸是重症脑卒中常见并发症，误吸可导致呛咳，严重者可引起吸入性肺炎，导致完全性或不完全性呼吸道梗阻，甚至引发急性左心衰、急性呼吸衰竭，甚至危及患者生命[1-3]。因此对于急诊重症监护室（Emergency intensive care unit，EICU）的重症脑卒中患者，了解其高危因素，有效预防误吸，具有重要的临床意义。既往有研究显示，生理因素、病理因素、进食方式、医源性因素是导致患者误吸的高危因素[4-5]。在这些因素中，部分因素可以通过相关干预预防误吸的发生。本次研究分析EICU的重症脑卒中患者发生误吸的高危因素，以期为临床预防提供参考，现报道如下。

1 资……