经口寰枢椎复位钢板术后医院获得性肺炎的相关因素分析

Correlative factors for hospital-acquired pneumonia in patients after surgery of transoral atlantoaxial reduction plate

目的探讨经口寰枢椎复位钢板(TARP)内固定手术患者发生医院获得性肺炎(HAP)的危险因素。方法收集189例行TARP手术患者的临床资料,评价术后肺部感染情况,分为HAP组与非HAP组,比较两组患者围术期观察项目的差异性,并进行logistic回归多因素分析。结果 25例占13.2%的患者发生医院获得性肺炎,单因素分析发现吸烟、术前低体重指数、气管切开、慢性肺疾病、机械通气、Frankle分级A^B、气管导管留置时间、抑酸药物使用时间、激素使用时间、鼻胃管留置时间、术中输液量、手术时间、血清白蛋白<35 g/L和血清钠<135 mmol/L与术后HAP有关;logistic多因素回归分析发现只有血清白蛋白<35 g/L(OR=5.404,P=0.016)、气管切开(OR=68.051,P=0.000)、Frankle分级A^B(OR=10.683,P=0.001)、气管导管留置时间>4 d(OR=8.009,P=0.002)、手术时间>6 h(OR=8.606,P=0.002)为独立危险因素。结论血清白蛋白<35 g/L、气管切开、Frankle分级A^B、气管导管留置时间>4 d、手术时间>6 h是TARP术后HAP的重要危险因素。

OBJECTIVE To study the risk factors for hospital-acquired pneumonia in patients after surgery of transoral atlantoaxial reduction plate.METHODS Totally 189 cases were collected from Jan 2004 to Jul 2010.18 variables among patients with HAP and without HAP were analyzed by logistic regression analysis.RESULTS The incidence of Hospital-acquired pneumonia in patients after surgery of transoral atlantoaxial reduction plate was 13.2%.There was significant difference in 14 variables between patients with HAP and without HAP and 5 variables were found to be significantly related to the development to hospital-acquired pneumonia by multivariate analysis： serum albumin〈35 g/L（OR=5.404,P=0.016）,tracheotomy（OR=68.051,P=0.000）,Frankle gradeA-B（OR=10.683,P=0.001）,the duration of intubation4 days（OR=8.009,P=0.002）,the duration of operation〉6 hours（OR=8.606,P=0.002）.CONCLUSION Serum albumin〈35 g/L,tracheotomy,Frankle gradeA-B,the duration of intubation〉4 days,the duration of operation〉6 hours are the risk factors for hospital-acquired pneumonia in patients after surgery of transoral atlantoaxial reduction plate.