重症颅脑损伤患者发生肺部感染的危险因素及其预防

目的 探讨重症颅脑损伤患者发生肺部感染的相关危险因素，为临床预防和控制感染提供依据。方法 选取海口市第三人民医院收治的408例重症颅脑损伤患者，根据是否发生肺部感染将其分为肺部感染组（149例）和无肺部感染组（259例），对肺部感染患者进行痰培养检查。应用多因素Logistic回归分析重症颅脑损伤患者发生肺部感染的危险因素。结果 408例重症颅脑损伤患者中肺部感染的发生率为36.52%（149/408）。149例肺部感染患者共分离出病原菌163株，以革兰阴性菌（67.48%）和革兰阳性菌（25.15%）为主。多因素Logistic回归分析发现，手术持续时间、机械通气时间、气管切开、引流管留置、GCS评分及APACHEⅡ评分是重症颅脑损伤患者发生肺部感染的独立危险因素，其OR（95%CI）值分别为5.837（3.125～13.168）、3.172（1.748～5.975）、5.106（2.683～11.829）、4.913（2.284～10.716）、3.625（1.972～7.218）、2.618（1.327～4.721）。结论 重症颅脑损伤患者肺部感染的发生率较高，应加强对其危险因素的早期预防和护理，降低感染的发生。

Risk factors and prevention of pulmonary infection in patients with severe traumatic brain injury

Objective The aim of this study was to investigate the risk factors of pulmonary infection in patients with severe traumatic brain injury, and thus to provide evidence for clinical prevention and control of infection. Methods 408 cases of severe craniocerebral injury patients were treated in the third people's hospital of Haikou city, and divided into pulmonary infection group(149 cases) and non-pulmonary infection group(259 cases) according to the occurrence of pulmonary infection. The sputum culture examination was peroformed in patients with pulmonary infection. Multivariate logistic regression analysis was used to analyze the risk factors of pulmonary infection in patients with severe traumatic brain injury. Results The incidence of pulmonary infection in 418 patients with severe craniocerebral injury was 36.52% (149/408). A total of 163 strains of pathogenic bacteria were isolated from 149 cases of pulmonary infection, with gram-negative bacteria(67.48%) and gram-positive bacteria(25.15%). Multiple factor logistic regression analysis showed that the duration of operation, tracheotomy, mechanical ventilation time, drainage tube indwelling, GCS score and APACHE score were independent risk factors of pulmonary infection in patients with severe craniocerebral injury, and the OR(95%CI) were 5.837 (3.125-13.168), 3.172(1.748-5.975), 5.106(2.683-11.829), 4.913(2.284-10.716), 3.625(1.972-7.218), 2.618(1.327-4.721), respectively. Conclusion The incidence of lung infection in patients with severe traumatic brain injury was high and it is necessary to strengthen the early prevention and care of the risk factors to reduce the incidence of infection.