开颅手术患者手术后肺炎的危险因素

目的探讨开颅患者手术后肺炎的危险因素及其预防策略。方法回顾性调查2014年1月—2015年12月某大型教学医院神经外科行开颅手术患者的病历资料。调查内容包括一般资料、手术情况及手术后肺炎发生情况等。分析开颅手术患者手术后肺炎的危险因素。结果共调查880例开颅手术后患者,发生手术后肺炎178例,发病率为20.23%。单因素分析结果显示年龄越大、术前合并基础疾病、ASA分级为Ⅲ-Ⅳ级、失血量大、手术持续时间长、术前住院日数长、术中输血、留置胃管、机械通气时间≥4 h、有气管切开、急诊手术的患者手术后肺炎的发病率较高,差异具有统计学意义(均P0.05)。非条件多因素logistic回归分析显示6个变量为手术后肺炎的独立危险因素,按OR值从大至小排序依次为气管切开[OR=27.73,95%CI(2.49～30.83)]、术后留置胃管[OR=4.55,95%CI(2.54～8.16)]、急诊手术[OR=4.34,95%CI(1.49～12.63)]、机械通气时间[OR=2.81,95%CI(1.37～5.75)]、术前住院时间[OR=1.06,95%CI(1.02～1.10)]、年龄[OR=1.03,95%CI(1.01～1.04)]。结论开颅手术患者手术后肺炎发病率高,应针对其危险因素采取有效防控措施,降低其感染率。

Risk factors for postoperative pneumonia in patients undergoing craniotomy

Objective To explore the risk factors and preventive strategies of postoperative pneumonia in patients undergoing craniotomy. Methods Medical records of patients who underwent craniotomy in the neurosurgery department of a large teaching hospital from January 2014 to December 2015 were surveyed retrospectively. The survey included general information, surgical conditions, and occurrence of postoperative pneumonia. Risk factors for pneumonia after craniotomy were analyzed. Results A total of 880 patients undergoing craniotomy were investigated, 178 patients (20.23%) had pneumonia after craniotomy. Univariate analysis showed that incidences of pneumonia were higher in patients with older age, preoperative complications of underlying diseases, ASA grade Ⅲ-IV, large blood loss, long duration of operation, long length of hospital stay before operation, intraoperative blood transfusion, indwelling gastric tube, mechanical ventilation time ≥ 4 hours, tracheotomy, and emergency surgery, difference were all significant (all P<0.05). Unconditional multivariate logistic regression analysis showed that six variables were independent risk factors for postoperative pneumonia. The OR from high to low were as follows:tracheotomy (OR, 27.73[95%CI, 2.49-30.83]), postoperative indwelling gastric tube (OR, 4.55[95%CI, 2.54-8.16]), emergency surgery (OR, 4.34[95%CI, 1.49-12.63]), mechanical ventilation time (OR, 2.81[95%CI, 1.37-5.75]), preoperative hospitalization time (OR, 1.06[95%CI, 1.02-1.10]), and age (OR,1.03[95%CI, 1.01-1.04]). Conclusion Incidence of postoperative pneumonia in patients undergoing craniotomy is high, effective prevention and control measures should be taken to reduce the incidence of infection according to risk factors.