Abstract:

Objective　To explore the values of applying the PLAN (problem, location, autonomy, number) and ASTRAL (age, sex, type of admission, risk factors, acuity of admission, length of stay) scoring systems in neurological nursing care for elderly patients with stroke-associated pneumonia (SAP). Methods　Two hundred and ten patients with SAP treated at Department of Neurology, Central Hospital Affiliated to Jiangnan University from January 2020 to January 2022 were retrospectively analyzed, including 102 males and 108 females. They were (70.85±8.32) years old. According to their survival status three months later, the patients were divided into a good prognosis group (168 cases) and a poor prognosis group (42 cases). The clinical data and scores of PLAN and ASTRAL were compared between these two groups. The risk factors of poor prognosis in the patients were analyzed by the logistic regression analysis. The values of the PLAN and ASTRAL scoring systems in the evaluation of the patients' prognosis were analyzed by the receiver operating characteristic curves (ROC). t, χ², and rank sum tests were applied. Results　There were statistical differences in gender, atrial fibrillation, hypertension, diabetes, coronary heart disease, and type of stroke between the two groups (all P>0.05). The good prognosis group were younger than the poor prognosis group [(68.58±5.70) years vs. (73.33±10.38) years], with a statistical difference (t=-4.002; P<0.05). The scores of PLAN and ASTRAL in the good prognosis group were lower than those in the poor prognosis group [11.2 (8.3, 13.1) vs. 16.3 (14.4, 20.6) and 20.0 (17.2, 23.1) vs. 28.1 (25.2, 32.1)], with statistical differences (Z=-5.536 and -5.576; both P<0.05). The logistic regression analysis results showed that the high scores of PLAN and ASTRAL and the old age were independent risk factors of poor prognosis in the elderly patients with SAP (all P<0.05). ROC was used to explore the values of the scores of PLAN and ASTRAL and their combination in the prediction of poor prognosis in the patients, and it found that their AUC's were 0.728, 0.680, and 0.800, respectively. The scores of PLAN and ASTRAL and their combination had certain values in predicting poor prognosis in the patients (all P<0.05). Conclusion　The PLAN and ASTRAL scoring systems have certain predictive value for the poor prognosis of elderly patients with SAP, and their combination has higher predictive value.

Key words:

Stroke-associated pneumonia, Scoring system, The elderly, Nursing, Prognosis

摘要：

目的　探讨院前合并症、意识水平、年龄和神经功能缺损（PLAN）评分及洛桑卒中量表（ASTRAL）评分在神经内科老年卒中相关性肺炎（SAP）护理中的应用价值。方法　回顾性分析2020年1月至2022年1月在江南大学附属中心医院神经内科治疗的老年SAP患者210例，其中男102例、女108例，年龄（70.85±8.32）岁。根据患者3个月后的生存情况，分为预后良好组（168例）和预后不良组（42例）。对比两组患者临床资料及PLAN、ASTRAL评分差异；采用logistic回归分析老年SAP患者预后不良的危险因素；采用受试者操作特征曲线（ROC）分析PLAN、ASTRAL评分对老年SAP患者预后价值。统计学方法使用t检验、χ²检验、秩和检验。结果　两组患者性别、房颤、高血压、糖尿病、冠心病及脑卒中类型比较，差异均无统计学意义（均P>0.05）；预后良好组患者年龄低于预后不良组［（68.58±5.70）岁比（73.33±10.38）岁］，差异有统计学意义（t=-4.002，P<0.05）。预后良好组患者PLAN及ASTRAL评分均低于预后不良组患者［11.2（8.3，13.1）分比16.3（14.4，20.6）分、20.0（17.2，23.1）分比28.1（25.2，32.1）分］，差异均有统计学意义（Z=-5.536、-5.576，均P<0.05）。logistic回归分析结果显示，PLAN及ASTRAL评分越高，年龄越大是老年SAP患者预后不良的独立危险因素（均P<0.05）。采用ROC评估PLAN及ASTRAL评分单独使用与二者联合使用在预测老年SAP患者预后不良方面的价值，发现AUC值分别为0.728、0.680、0.800，结果表明，PLAN及ASTRAL评分以及联合应用在预测老年SAP患者预后不良方面具有一定的预测价值（均P<0.05）。结论　PLAN及ASTRAL评分对老年SAP患者预后不良方面具有一定的预测价值，二者联合预测，价值更高。

关键词:

卒中相关性肺炎, 评分系统, 老年人, 护理, 预后