Muratova T. M., Khramtsov D. M., Busel S. V., Batashova-Galinska V. A., Bobrovsky K. A.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

In the structure of the comorbidity of a stroke, an important part is presented by diseases of the respiratory organs, including pneumonia. Due to the fact that in Ukraine patients are still admitted to treatment facilities outside the therapeutic window, not only late nosocomial poststroke pneumonia, but also nonhospital, becomes relevant. The purpose of the study was to evaluate the effectiveness of the diagnosis of comorbid pathology of the chest organs at the prehospital stage in patients with ischemic stroke. Object and methods. The research was carried out on the basis of CRRM of ONMEDU during 2016-2018. The results of CT scan analysis of 247 patients who were candidates for hospitalization to the stroke center of the clinic were analyzed. The tests were performed on 16 cutting units Aquillon – 16 TOSHIBA (Japan). There were evaluated the frequency of detection of extubation pneumonia, signs of chronic obstructive pulmonary disease, disseminated processes, metatuberculous changes, primary and secondary tumor lesions. Comparison of identified nosologies with localization and severity of stroke was performed. Statistical processing was carried out using frequency analysis methods using the Statistica 10.0 (Dell StatSoft Inc., USA) software. Research results. An analysis of the frequency of detection at the pre-hospital stage was performed during MSCT screening of out-hospital and late hospital pneumonia, pulmonary hypostases, COPD and tumor pathology. The role of the severity of a stroke and the period since the onset of the first symptoms of a stroke in the occurrence of broncho-pulmonary pathology has been determined. The expediency of the use of MSCT screening in specialized medical institutions that help with acute cerebrovascular disruption is discussed. Conclusions 1. At the time of admission to the hospital, 12.6% of patients with ischemic stroke had signs of extubation pneumonia. 2. Late hospitalized pneumonia is detected in 11.3% of patients with stroke whereas only 6.1% of the diagnosis was established prior to hospitalization. 3. A common occurrence in patients with stroke is hypostasis in the lungs, which is determined in 44.1% of patients. 4. In a large number of patients (19.8%), CT scan of chest was detected during MSCT screening and 2.0% had tumor pathology. 5. Pneumonia is more frequently detected in patients who arrived in the hospital 48 hours or later after symptoms (rA = 0.71), as well as with more severe stroke (NIHSS> 8 points) – rA = 0.64. Instead, the localization of the stroke had little effect on the incidence of bronchopulmonary disease – rA = 0.37. 6. The use of MSCT screening can improve the efficiency of the diagnosis of comorbid pathology of the chest organs in patients with ischemic stroke in the prehospital stage. 7. MSCT-screening of diseases of the chest organs can be recommended for the primary examination of patients with acute cerebrovascular disorder for facilities of the 3rd level of medical care and university clinics that have their own stroke centers.

stroke, comorbid pathology, computed tomography, chest organs

1. Thrift AG, Thayabaranathan T, Howard G, Howard VJ, Rothwell PM, Feigin VL, et al. Global stroke statistics. Int J Stroke. 2017 Jan;12(1):13-32.
2. Townsend N, Nichols M, Scarborough P, Rayner M. Cerebrovasular disease in Europe-epidemiological update. Eur Heart J. 2015 Oct 21;36(40):2696-705.
3. Nakaz MOZ Ukrayiny vid 03.08.2012 № 602 “Pro zatverdzhennya ta vprovadzhennya medyko-tekhnolohichnykh dokumentiv zi standartyzatsiyi medychnoyi dopomohy pry ishemichnomu insulʹti”. Dostupno: http://old.moz.gov.ua/ua/portal/dn_20120803_602.html [in Ukrainian].
4. Hu HY, Chi WC, Chang KH, Yen CF, Escorpizo R, Liao HF, et al. The World Health Organization Disability Assessment Schedule 2.0 can predict the institutionalization of patients with stroke. Eur J Phys Rehabil Med. 2017 Dec;53(6):856-62.
5. Zozulya IS, Zozulya AI, Volosovetsʹ AO. Deyaki napryamky polipshennya nadannya medychnoyi dopomohy pry mozkovomu insulʹti. Ukr. visn. psykhonevrol. 2017;25(1):84-5. [in Ukrainian].
6. Mishchenko TS. Epidemiologiya tserebrovaskulyarnykh zabolevaniy i organizatsiya pomoshchi bol’nym s mozgovym insul’tom v Ukraine. Ukr. vísn. psikhonevrol. 2017;25,1(90):22-4. [in Russiаn].
7. Teh WH, Smith CJ, Barlas RS, Wood AD, Bettencourt-Silva JH, Clark AB, et al. Impact of stroke-associated pneumonia on mortality, length of hospitalization, and functional outcome. Acta Neurol Scand. 2018 Oct;138(4):293-300.
8. Umarova KhYa, Chugunov AV, Agapov AA, Kamchatnov PR. Pnevmoniya u bol’nykh s ostrym mozgovym insul’tom. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2007;107(21):25-9. [in Russiаn]. 
9. Hannawi Y, Hannawi B, Rao CP, Suarez JI, Bershad EM. Stroke-associated pneumonia: major advances and obstacles. Cerebrovasc Dis. 2013;35(5):430-43.
10. Ali AN, Howe J, Majid A, Redgrave J, Pownall S, Abdelhafiz AH. The economic cost of stroke-associated pneumonia in a UK setting. Top Stroke Rehabil. 2018 Apr;25(3):214-23.
11. Claessens YE, Debray MP, Tubach F, Brun AL, Rammaert B, Hausfater P, et al. Early Chest Computed Tomography Scan to Assist Diagnosis and Guide Treatment Decision for Suspected Community-acquired Pneumonia. Am J Respir Crit Care Med. 2015 Oct 15;192(8):974-82.
12. Nascimento Alves P, Silva C, Baptista J, Lima B, Jacinto M, Trigueiros F, et al. Laterality of Pneumonia in Acute Stroke. Eur Neurol. 2017;77(12):75-9.
13. Dziedzic T, Pera J, Klimkowicz A, Turaj W, Slowik A, Rog TM, et al. Serum albumin level and nosocomial pneumonia in stroke patients. Eur J Neurol. 2006 Mar;13(3):299-301.
14. Wagner C, Marchina S, Deveau JA, Frayne C, Sulmonte K, Kumar S. Risk of Stroke-Associated Pneumonia and Oral Hygiene. Cerebrovasc Dis. 2016;41(1-2):35-9.
15. Hoffmann S, Harms H, Ulm L, Nabavi DG, Mackert BM, Schmehl I, et al. Stroke-induced immunodepression and dysphagia independently predict stroke-associated pneumonia – The PREDICT study. J Cereb Blood Flow Metab. 2017 Dec;37(12):3671-82.
16. Cacho-Díaz B, Lorenzana-Mendoza NA, Spínola-Maroño H, Reyes-Soto G, Cantú-Brito C. Comorbidities, Clinical Features, and Prognostic Implications of Cancer Patients with Cerebrovascular Disease. J Stroke Cerebrovasc Dis. 2018 Feb;27(2):365-71.
17. Spatenkova V, Krejzarova P, Jedlicka J. Pre-stroke undiagnosed dysphagia lusoria as a rare cause of aspiration pneumonia with respiratory failure in a stroke patient. SAGE Open Med Case Rep. 2018 Mar 8. Available from: https://doi.org/10.1177/2050313X18761308
18. Simonov SS. Negospital’naya pnevmoniya: klassifikatsiya, diagnostika, lecheniye. Ukraіns’kiy medichniy zhurnal. 2011;2(82):11-4. Dostupno: https://www.umj.com.ua/article/11570/negospitalnaya-pnevmoniya-klassifikaciya-diagnostika-lechenie [in Russiаn].
19. Nakaz MOZ Ukrayiny vid 04.09.2014 № 620 “Pro zatverdzhennya ta vprovadzhennya medyko-tekhnolohichnykh dokumentiv zi standartyzatsiyi medychnoyi dopomohy pry tuberkulʹozi”. Dostupno: http://old.moz.gov.ua/ua/portal/dn_20140904_0620.html [in Ukrainian].
20. Tyurin YeI. Rentgenodiagnostika vnebol’nichnykh pnevmoniy. Luchevaya diagnostika. 2017;3:7-11. Dostupno: http://www.poliklin.ru/ imagearticle/2013_Luchi/7-11.pdf [in Russiаn].
21. Koo HJ, Lim S, Choe J, Choi SH, Sung H, Do KH. Radiographic and CT Features of Viral Pneumonia. Radiographics. 2018 May-Jun;38(3):719-39.
22. Lokalʹnyy klinichnyy protokol «Ishemichnyy insulʹt». Odesa; 2018. 45 s. [in Ukrainian].

«Bulletin of problems biology and medicine» Issue 1 Part 1 (148), 2019 year, 144-148 pages, index UDK 616.24-002+616.831-005

10.29254/2077-4214-2019-1-1-148-144-148