急性出血性脑卒中开颅术后下呼吸道感染的危险因素及临床分析

目的探讨急性出血性脑卒中开颅术后下呼吸道感染的危险因素并临床分析。 方法回顾性分析天津市泰达医院神经外科自2012年1月至2020年12月收治的674例行开颅手术的出血性脑卒中患者的临床资料包括性别、年龄、出血部位、意识障碍、瞳孔变化、糖尿病病史、慢性阻塞性肺疾病（COPD）史]，根据术后是否合并下呼吸道感染将患者分为下呼吸道感染组和无下呼吸道感染组，单因素分析2组患者临床资料的差异，总结下呼吸道感染的致病菌和用药方式。 结果674例患者中术后出现下呼吸道感染者239例，无呼吸道感染者435例，2组患者的年龄、意识障碍状态、术前瞳孔散大情况、糖尿病史、COPD病史等比较，差异均有统计学意义（P<0.05）。下呼吸道感染的致病菌革兰氏阴性菌占68.4%，革兰氏阳性菌占29.8%，真菌占1.8%。下呼吸道感染组住院时间平均18.23 d。无下呼吸道感染组住院时间平均14.47 d。 结论出血性脑卒中术后下呼吸道感染的发病率与患者的年龄、意识状态、瞳孔变化、糖尿病史、COPD病史等临床特征有关，早期予以针对性抗炎治疗可以降低术后患者下呼吸道感染的发病率，改善患者预后。

Risk factors and clinical analysis of lower respiratory tract infection after craniotomy in acute hemorrhagic stroke

ObjectiveTo investigate the risk factors and clinical analysis of lower respiratory tract infection after craniotomy in patients with acute hemorrhagic stroke. MethodsThe clinical data of 674 patients with hemorrhagic stroke who underwent craniotomy in Neurosurgery Department of Tianjin TEDA Hospital from January 2012 to December 2020 were selected, including gender, age, bleeding site, disturbance of consciousness, pupil changes, history of diabetes, history of chronic obstructive pulmonary disease (COPD). According to whether the patients were complicated with lower respiratory tract infection or not, the patients were divided into lower respiratory tract infection group and no lower respiratory tract infection group. Univariate analysis was used to analyze the differences of clinical data between the two groups, and the pathogenic bacteria and medication methods of lower respiratory tract infection were summarized. ResultsThere were 239 cases of lower respiratory tract infection and 435 cases of no respiratory tract infection in 674 patients. There were significant differences in age, state of consciousness, preoperative mydriasis, history of diabetes and COPD between the two groups (P<0.05). The pathogenic bacteria of lower respiratory tract infection were G^- bacteria accounted for 68.4%, G⁺ bacteria 29.8%, fungi 1.8%. The average hospitalization time of lower respiratory tract infection group was 18.23 d. The average length of stay in the group without lower respiratory tract infection was 14.47 d. ConclusionThe incidence rate of lower respiratory tract infection after hemorrhagic stroke is related to the age, state of consciousness, pupil changes, diabetes history, COPD history and other clinical characteristics. Early targeted anti-inflammatory treatment can reduce the incidence rate of lower respiratory tract infection and improve the prognosis of patients after operation.