卒中相关性肺炎

ents with depressed consciousness. American Journal of Medicine 1978;64: 564–68.?Gleeson K, Eggli DF, Maxwell SL.Quantitative aspiration during sleep in normal subjects. Chest 1997;111:1266–72.?Perry L, Love CP.Screening for dysphagia and aspiration in acute stroke:a systematic review. Dysphagia 2001;16:7–18.?Hinchey JA, et al.Formal dysphagia screening protocols prevent pneumonia. Stroke Practice work Investigators. Stroke 2005;36: 1972–1976.Р卒中相关性肺炎具有更为复杂的病理生理基础?和单纯吸入性肺炎有一定差别Р脑卒中发生后由于意识障碍或者呼吸驱动异常而需要置入人工气道甚至机械通气的患者,在气管插管或气管切开进行机械通气治疗48~72小时后或者去除人工气道48小时内发生的肺炎,属呼吸机相关性肺炎(Ventilator associated pneumonia,VAP),其诊断、治疗和预防策略参阅相关指南。Р临床诊断Р脑卒中发生后新出现或进展性肺部浸润性病变,合并2个以上临床症状:发热≥38℃;新出现的咳嗽、咳痰,并出现脓性分泌物,伴或不伴胸痛;肺实变体征,和(或)湿罗音;外周血白细胞≥10×109/L或≤4×109/L,伴或不伴核左移。Р排除与肺部感染临床表现相近的情况,如肺结核、肺部肿瘤、非感染性肺间质病、肺水肿、肺不张、肺栓塞等。