颅内破裂动脉瘤开颅夹闭术后并发肺炎的危险因素

目的 探讨颅内破裂动脉瘤开颅夹闭术后并发肺炎的危险因素。方法 回顾性分析2017年1月1日至2018年12月1日开颅夹闭术治疗的114例颅内破裂动脉瘤的临床资料。采用多因素logistic回归分析检验危险因素。结果 114例中，36例（31.5%）发生肺炎。多因素logistic 回归分析发现术前Hunt-Hess分级4~5级、术中出血量大、术后当天血红蛋白水平低是术后发生肺炎的独立危险因素（P<0.05）。ROC曲线分析结果显示术中出血量为325 ml、术后当天血红蛋白水平为106 g/L是术后肺炎的最佳判别界值。结论 对开颅夹闭术治疗颅内破裂动脉瘤，病情重、术中出血量大的病人，术后发生肺炎风险明显增加，临床应注意防治。

Analysis of risk factors related to pneumonia after clipping of aneurysms in patients with aneurismal subarachnoid hemorrhage

Objective To analyze the high risk factors related to pneumonia after clipping of aneurysms in the patients with aneurismal subarachnoid hemorrhage (aSAH). Methods Of 114 patients with aSAH who underwent the clipping of aneurysms from January 1, 2017 to December 1, 2018 in our department, 36 had postoperative pneumonia (PPA) and 78 not. The factors related to PPA were statistically analyzed. Results The univariate analysis showed that the factors related to PPA included the hypertension history, preoperative Hunt-Hess grade and Fisher grade, intraoperative aneurismal rupture, decompressive craniectomy, operation duration, intraoperative bleeding volume, intraoperative transfusion of blood and hemoglobin level and plasma albumin level on the postoperative day (P<0.05). The multivariate logistic regression analysis showed that the risk factors related to PPA included the preoperative Hunt-Hess grades 4~5, large volume of bleeding during the operation and low level of hemoglobin on the postoperative day (P<0.05). The receiver operating characteristic curve calculated that the more volume of intraoperative bleeding than 325 ml, and the lower plasma hemoglobin level than 106 g/L on the postoperative day were the discriminant threshold for the occurrence of postoperative pneumonia. Conclusion The preoperative Hunt-Hess grades 4~5, more volume of intraoperative hemorrhage than 325 ml and lower plasma hemoglobin level than 106 g/L on the postoperative day may indicate an increase in the incidence of PPA in the patients with aSAH undergoing the clipping of aneurysms.