颅脑术后患者下呼吸道感染及预后相关因素分析

Analysis of the related factors of craniocerebral operations patients with lower respiratory tract infection and prognosis

目的 探讨颅脑手术后患者发生下呼吸道感染及预后的相关因素。方法 收集2014年12月~2015年7月我院242例颅脑术后患者的临床资料,应用多因素分析发生下呼吸道感染及预后的相关因素。结果 242例颅脑术后患者发生下呼吸道感染64例,感染率为26.45%,合并下呼吸道感染患者经治疗后死于多器官功能衰竭34例。64例下呼吸道感染患者中共分离出病原菌87株,以革兰阴性菌为主,占77.01%,其次是革兰阳性菌,占13.79%,真菌占9.20%;年龄、高血压、糖尿病、手术类型、住院时间、侵入性操作（吸痰、气管插管、气管切开）、GCS评分、手术时间、糖皮质激素使用、抗生素种类、术后低白蛋白、抑酸剂使用、脱水剂使用、吸烟与患者发生下呼吸道感染有关（P〈0.05）,其中死亡组与对照组GCS评分、术后低白蛋白比较,差异有统计学意义（P〈0.05）。多因素分析显示,GCS评分、侵入性操作（吸痰、气管插管、气管切开）、抗生素种类是颅脑术后患者发生下呼吸道感染的独立危险因素（P〈0.05）,GCS评分、术后低白蛋白是颅脑术后患者并发下呼吸道感染死亡的独立危险因素（P〈0.05）。结论颅脑术后患者下呼吸道感染的发生与GCS评分低、抗生素的不合理使用及侵入性操作有密切相关性,GCS评分低和术后低白蛋白的患者预后差,应在临床工作中针对以上危险因素进行必要干预,以降低下呼吸道感染的发生率,改善患者预后。

Objective To investigate the related factors of craniocerebral operations patients with lower respiratory tract infection and prognosis. Methods The clinical date of 242 patients with craniocerebral operations from December 2014 to July 2015 were collected, and the related risk factors for infection and prognosis were analyzed by multiple factors analysis. Results Among 242 patients with craniocerebral operations, lower respiratory tract infection occurred in 64 patients, and the incidence of infection was 26.45%. 34 cases of lower respiratory tract infection died of multiple organ failure after treatment. A total of 87 strains of pathogenic bacteria were detected in 64 patients with lower respiratory tract infection,including gram-negative bacteria（77.01%）, gram-positive bacteria（13.79%）, and fungi（9.20%）. age, hypertension, diabetes, operation type, duration of hospitalization, invasive procedures（sputum aspiration, tracheal intubation, tracheotomy）, GCS score, operation time, glucocorticoid use, types of antibiotics, postoperative low albumin,antacids use, dehydrator use, smoke were related to the occurrence of lower respiratory tract infection（P0.05）, in which the death group and the control group of GCS score, postoperative low albumin, the difference was statistically significant（P0.05）. Multiple factor analysis showed that GCS score, invasive procedures（sputum aspiration, tracheal intubation, tracheotomy）, types of antibiotics were independent risk factors for lower respiratory tract infection after craniocerebral operation（P0.05）, GCS score, postoperative low albumin were independent risk factors for death of lower respiratory tract infection after craniocerebral operation（P0.05）. Conclusion Low GCS score, irrational use of antibiotics,invasive procedures are relative to the incidence of lower respiratory tract infection after craniocerebral operation, the prognosis of patients with low GCS score and postoperative low albumin is poor, the necessary intervention should be carried out in the clinical work for the above risk factors to reduce the incidence of lower respiratory tract infection and improve the prognosis of patients.