胸部损伤患者继发肺部感染原因分析及防治对策

Causes and countermeasures for secondary pulmonary infections in patients after chest trauma

目的探讨胸部损伤患者继发肺部感染的危险因素,为采取有效地防治对策,降低其发生率提供科学依据。方法回顾性分析172例胸部损伤患者的临床资料,统计其感染发生率,分析肺部感染的危险因素。结果 172例胸部损伤患者继发肺部感染68例,感染率39.54%;单因素分析显示,胸部损伤患者继发肺部感染与患者年龄(χ2=42.64,P=0.000)、吸烟(χ2=12.30,P=0.000)、糖尿病(χ2=9.85,P=0.002)、慢性炎性肺疾病(χ2=27.31,P=0.000)、损伤程度(χ2=37.49,P=0.000)、有创治疗操作(χ2=48.80,P=0.000)等因素有关;多因素logistic回归分析显示,胸部损伤程度(OR=7.821,P=0.000)、糖尿病(OR=3.763,P=0.039)、有创治疗操作(OR=3.392,P=0.013)、慢性炎性肺疾病(OR=3.322,P=0.041)、年龄(OR=2.954,P=0.026)、吸烟(OR=0.382,P=0.035)是继发肺部感染的主要危险因素。结论胸部损伤后继发肺部感染发生率较高;胸部损伤程度、糖尿病、有创治疗操作、慢性炎性肺疾病、年龄、吸烟是胸部损伤患者继发肺部感染的危险因素,应针对性加以预防治疗。

OBJECTIVE To explore the risk factors for secondary pulmonary infections in the patients with chest trauma so as to take effective prevention and treatment measures to reduce the incidence of pulmonary infections. METHODS The clinical data of 172 cases with chest trauma in the hospital were retrospectively analyzed, the incidence of the infections was taken for statistics, and the risk factors of pulmonary infections were analyzed. RESULTS The pulmonary infections occurred in 68 of 172 cases of patients with chest trauma with the infection rate of 39.54~. Univariate analysis showed that the pulmonary infections were related to the age（z2 =42.64 ,P= 0. 000）, smoking（z2 =12.30,P=0. 000）, diabetes（z2 = 9.85 ,P=0. 002）, chronic inflammatory lung disease（z2 =27.31,P=0. 000）, injury severity（;~2 =37.49,P=0. 000）, and invasive operation （Z2 =48.80,P= 0. 000） ; while the multivariate logistic regression analysis showed that the severity of chest trauma（OR = 7. 821, P= 0. 000）, diabetes（OR= 3. 763,P=0.0＇39）, invasive operation（OR^3. 392,P=0. 013）, chronic inflammatory lung disease（OR = 3. 322, P = 0.041 ）, age （OR -- 2.954, P = 0.026 ）, and smoking （OR = 0.382, P ~ 0.035 ） were the major risk factors of the secondary pulmonary infections. CONCLUSION The incidence of secondary pulmonary infections after chest trauma is high. The severity of chest trauma, diabetes, invasive operation, chronic inflammatory lung disease, age, and smoking are the risk factors of the secondary pulmonary infections in the patients with chest trauma. It is necessary to take targeted prevention measures.