重症颅脑损伤患者肺部感染的危险因素

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,为临床预防和控制其肺部感染提供依据。方法选取海口市第三人民医院收治的418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(152例)和无肺部感染组(266例),对肺部感染患者进行痰培养。应用单因素及多因素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 418例重症颅脑损伤患者中肺部感染发病率为36.4%(152/418)。152例肺部感染患者共分离出病原菌168株,以革兰阴性菌(66.7%)和革兰阳性菌(25.0%)为主。单因素及多因素logistic回归分析,发现手术持续时间≥4 h、机械通气时间≥7 h、有气管切开、留置引流管、GCS评分5分及APACHEⅡ评分≥18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病率较高,应加强患者的护理及其危险因素的早期预防,降低肺部感染的发生。

Risk factors for pulmonary infection in patients with severe craniocerebral injury

ObjectiveTo explore the risk factors for pulmonary infection(PI) in patients with severe craniocerebral injury, and provide basis for clinical prevention and control of PI.Methods418 patients with severe craniocerebral injury and admitted to the Third People’s Hospital of Haikou were selected, they were divided into PI group (n=152) and non PI group (n=266) according to whether the PI occurred, sputum culture of patients with PI was performed. Univariate and multivariate logistic regression analysis were conducted to analyze the risk factors for PI in patients with severe craniocerebral injury.ResultsIncidence of PI in 418 patients with severe craniocerebral injury was 36.4% (152/418). 168 strains of pathogens were isolated from 152 patients with PI, mainly gram negative bacteria (66.7%) and gram positive bacteria (25.0%). Univariate and multivariate logistic regression analysis showed that duration of surgery≥4 hours, mechanical ventilation≥7 hours, tracheotomy, drainage tube indwelling, Glasgow Coma Scale (GCS)<5, and acute physiology and chronic health evaluation (APACHE II) score≥18 were independent risk factors for PI in patients with severe craniocerebral injury, OR (95%CI) values 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）, and 2.618（1.327-4.721）respectively.ConclusionIncidence of PI in patients with severe craniocerebral injury is high, it is necessary to strengthen nursing and early prevention according to risk factors, so as to reduce the incidence of PI.