脑出血患者肺部感染的危险因素分析

Risk factors for pulmonary infections in patients with cerebral hemorrhage

目的探讨脑出血患者发生肺部感染的危险因素,以达到提高临床诊治水平。方法选取2006年1月-2013年2月脑出血患者670例,对其临床资料和治疗过程进行回顾性分析,采用SPSS13.0软件进行统计分析,对脑出血患者并发肺部感染的危险因素使用logistic回归分析进行多因素分析。结果 670例脑出血患者发生肺部感染88例,感染率为13.13%,性别、是否吸烟和嗜酒对于肺部感染发生影响不大,差异无统计学意义;年龄>70岁、神志昏迷、合并糖尿病、肺部疾病患者发生肺部感染的概率明显增加,差异有统计学意义(P<0.05);行鼻饲胃管、使用糖皮质激素、H2受体阻滞剂、抗菌药物以及住院时间>20d均可增加患者发生肺部感染的概率(P<0.05);患者合并昏迷、糖尿病、少数患者行气管切开、气管插管、鼻饲胃管及给予H2受体阻滞剂治疗、未预防性应用抗菌药物以及住院时间>20d均是患者发生肺部感染的独立危险因素(P<0.001)。结论对脑出血患者进行治疗时应积极改善患者自身机体状况,建立良好的生活和饮食习惯、减少患者的住院时间、合理应用抗菌药物,并在进行侵入性操作时严格无菌原则,以期降低患者肺部感染发生率,获得良好的预后。

OBJECTIVE To explore the risk factors for pulmonary infections in patients with cerebral hemorrhage so as to improve level of clinical diagnosis and treatment. METHODS Totally 670 cases of cerebral hemorrhage who were treated in the hospital from Jan 2006 to Feb 2013 were enrolled in the study, then the clinical data and the treatment process were retrospectively analyzed, the statistical analysis was performed with the use of SPSS13.0 software, and the multivariate logistic regression analysis was conducted for the risk factors for pulmonary infections in the patients with cerebral hemorrhage. RESULTS Of the 670 cases of cerebral hemorrhage, the pulmonary infections occurred in 88 cases with the infection rate of 13.13~/00. The age, smoking, and alcohol addict has little influence on the incidence of pulmonary infections, and the differences were not significant; the incidence of pul monary infections was significantly increased in the patients with more than 70 years of age, unconsciousness, complication of diabetes, or pulmonary disease （P^0. 05）. Nasogastric intubation, use of corticosteroids, H2 blockers, or antibiotics, and length of hospital stay more than 20 days could increase the risk of pulmonary infections（P〈0.05）. The independent risk factors for the pulmonary infections included the complication of coma or diabetes, tracheotomy, intracheal intubation, nasogastric intubation, use of H2 blocker, without prophylactic use of antibiotics, and length of hospital stay more than 20 days （P〈0. 001）. CONCLUSION For the patients with cerebral hemorrhage, it is necessary to actively improve their own body conditions, develop good living and diet hab it, shorten the length of hospital stay, reasonably use antibiotics, and strictly conform to aseptic principles for invasive operations so as to reduce the incidence of pulmonary infections and acquire good prognosis.