神经重症患者肺部感染的危险因素分析

目的明确神经外科重症患者并发肺部感染的影响因素,为肺部感染的防治提供参考。方法选择中山大学附属第八医院(深圳福田)神经外科自2017年5月至2018年5月收治的65例神经重症并发肺部感染患者进入研究,收集患者一般资料、实验室检查结果、胸部CT等影像检查结果,以及住院时间、抗生素/呼吸机使用情况、有无气管切开等治疗情况,明确影响神经重症患者肺部感染的独立因素。结果本组患者中不同病种患者肺部感染发生率差异有统计学意义(P<0.05),脑出血性疾病患者感染率最高,达到50.8%(32/63)。入院GCS评分(OR=2.903,95%CI:1.069~7.881,P=0.037)、血清白蛋白含量(OR=3.690,95%CI:1.157~11.768,P=0.027)、使用呼吸机(OR=15.799,95%CI:6.305~39.591,P=0.000)、气管切开或气管插管(OR=7.036,95%CI:2.913~16.993,P=0.000)、糖尿病病史(OR=2.442,95%CI:1.026~5.809,P=0.043)、预防性使用抗生素(OR=6.021,95CI%:2.340~15.489,P=0.000)是神经重症患者发生肺部感染的独立危险因素。结论促进患者意识恢复,缩短住院时间,减少气管插管和呼吸机使用,纠正低蛋白血症和糖尿病等并发症能有效防止神经重症患者肺部感染的发生。

Risk factors for pulmonary infection in severe neurological patients

Objective To analyze the influencing factors for pulmonary infection in neurosurgical critical patients,and provide references for prevention and treatment of pulmonary infection.Methods Sixty-five patients with severe neurological diseases complicated with pulmonary infection,admitted to our hospital from May 2017 to May 2018,were chosen in our study.General information,laboratory examination results,chest CT and other imaging results,hospital stay,antibiotic/ventilator use,tracheotomy and other treatments of these patients were collected and compared to identify the independent factors influencing pulmonary infection in patients with severe neurological disease.Results There was a statistically significant difference in incidence of pulmonary infection among patients with different diseases(P<0.05),and the infection rate of patients with cerebral hemorrhage was the highest,reaching to 50.8%(32/63).GCS scores(OR=2.903,95%CI:1.069-7.881,P=0.037),serum albumin level(OR=3.690,95%CI:1.157-11.768,P=0.027),ventilator use(OR=15.799,95%CI:6.305-39.591,P=0.000),tracheotomy or endotracheal intubation(OR=7.036,95%CI:2.913-16.993,P=0.000),history of diabetes(OR=2.442,95%CI:1.026-5.809,P=0.043),and prophylactic use of antibiotics(OR=6.021,95CI%:2.340-15.489,P=0.000)were independent risk factors for pulmonary infection in patients with severe neurological conditions.Conclusion Effective measurements,including recovering consciousness as soon as possible,shortening accommodation,actively avoiding endotracheal intubation and ventilator-associated pneumonia,and rectifying hypoproteinemia and diabetes mellitus can effectively prevent the occurrence of severe pulmonary infection of neurosurgical critical patients.