重型颅脑损伤患者肺部感染危险因素的Logistic回归分析及护理对策

Logistic regression analysis of risk factors of pulmonary infection in patients with severe brain injury and nursing countermeasures

目的探讨重度颅脑损伤患者并发肺部感染的危险因素及其防护对策。方法回顾性分析我院320例重型颅脑损伤患者的临床资料，将并发肺部感染的101例患者作为病例组，按1：1的比例选择同期住院未发生肺部感染的101例颅脑损伤患者作为对照组，对可能引发患者发生肺部感染的相关因素进行单因素及多因素Logistic回归分析。结果单因素分析结果显示，高龄、格拉斯哥昏迷评分（GCS）低、卧床时间长、长时间使用激素、长时间使用抗生素、合并基础病、呼吸机应用、气管切开、长期吸烟史、留置胃管是重型颅脑损伤患者并发肺部感染的相关危险因素；多因素Logistic回归分析发现呼吸机应用、合并基础病、卧床时间是重型颅脑损伤患者并发肺部感染的独立危险因素，而GCS评分高是保护因素。结论重型颅脑损伤患者肺部感染的发生与呼吸机应用、合并基础病、长时间卧床及GCS评分低有关，医护人员应及早识别相关危险因素并采取有效预防措施控制肺部感染的发生。

Objective To study the risk factors and to provide preventive measures of pulmonary infection for patients with severe brain injury. Methods A total of 320 patients with severe brain injury were analyzed with hospital-based case-control study method. A total of 101 patients complicated with lung infection were set as the experimental group. Another 101 patients with no pulmonary infection according to the proportion of 1：1 choice over the same period were set as the control group. The related factors were an- alyzed with the univariate analysis and the multiple factors Logistic regression analysis. Results Univariate analysis showed that the occurrence of pulmonary infection of patients with severe brain injury was closely related to the old age, low GCS score, long time stay in the bed, long time hormone application, long time antibiotic application, the combined underlying disease, use of mechanic ventilation, long-term smoking history and indwelling gastric tube. Multivariable Logistic regression analysis showed that the application of mechanic ventilator, the combined underlying disease and long time stay in bed were the independent risk factors for pulmonary infection of patients with severe brain injury, but GCS score was a protective factor. Conclusions The occurrence of lung infection were related to the ventilator application, the com- bined underlying disease, long time stay in bed and low GCS score. Considering these risk factors, the med- ical staffs should take preventive measures early to control lung infection.