神经外科手术患者医院获得性肺炎的危险因素分析

The risk factors of hospital-acquired pneumonia after neurosurgical operations

目的探讨神经外科手术后患者医院获得性肺炎（HAP）的危险因素,为医院相关控制措施的制定提供理论依据。方法采用非条件Logistic回归分析及χ2检验分析533例神经外科手术患者的临床资料,探索HAP发生的危险因素。结果纳入的研究对象中共89例发生HAP,感染率为16.70%;采用χ2检验进行单因素分析结果显示,差异具有统计学意义的指标为患者年龄、手术类型、麻醉类型、手术时间、术中失血量、美国麻醉师协会（ASA）评分、植入物、应用抗菌药物、术前住院天数、术后住院天数及全部住院天数（P均〈0.05）;进一步Logistic多因素回归分析发现,年龄（OR=4.08,95%CI：2.18~7.65）、ASA评分（OR=4.44,95%CI：2.06~9.59）及全部住院天数（OR=2.90;95%CI：1.21~6.97）是HAP的独立危险性因素;而择期手术（OR=0.54;95%CI：0.30~0.97）及使用抗菌药物（OR=0.31;95%CI：0.12~0.79）是独立的保护性因素。结论针对危险性因素做好有效的预防是控制医院获得性肺炎的关键。

Objective To investigate the risk factors of hospital acquired pneumonia（HAP） after neurosurgical operations, and to provide theoretical basis for the formulate of hospital-related control measures. Methods The clinical data of 533 patients with neurosurgical operations were analyzed by multivariate Logistic regression analysis and χ~2 test, while the risk factors of HAP were detected. ResultsAmong the 533 cases, 89（16.70%） cases were with HAP. The results of processing χ~2 test showed that 11 factors had significant difference（P all 0.05）, including the age, surgery type, anesthesia type, operative time, loss of blood intraoperative, ASA score, implants, use of antimicrobial drugs, preoperative, postoperative and overall hospitalization period. The multivariate Logistic regression analysis showed that the age（OR = 4.08, 95%CI： 2.18-7.65）, ASA score（OR = 4.44, 95%CI： 2.06-9.59） and overall hospitalization days（OR = 2.90, 95%CI： 1.21-6.97） were independent risk factors of HAP, respectively. While elective surgery（OR = 0.54, 95%CI： 0.30-0.97） and using antimicrobial drugs（OR = 0.31, 95%CI： 0.12-0.79） were independent protective factors. Conclusions Effective prevention of the risk factors was the key to control the hospital acquired pneumonia.