结核性脑膜炎患者出现呼吸衰竭的危险因素分析

Risk Factors for Respiratory Failure in Patients With Tuberculous Meningitis

目的分析结核性脑膜炎患者出现呼吸衰竭的危险因素,为临床诊治结核性脑膜炎提供参考。方法回顾性分析2014-01—2017-06在新疆维吾尔自治区胸科医院住院的经临床诊断或实验室诊断明确的368例结核性脑膜炎患者,排除115例。其中83例发生呼吸衰竭的患者为A组,抽样83例未出现呼吸衰竭的患者为B组。收集2组患者的临床资料,对危险因素进行Logistic回归分析。结果单因素分析发现,年龄(χ~2=8.149,P=0.004)、头部外伤史(χ~2=6.760,P=0.009)、发病时间(χ~2=35.687,P=0.000)、GCS评分(χ~2=40.886,P=0.000)、肺部感染(χ~2=45.413,P=0.000),合并脑梗死(χ~2=7.000,P=0.008)等6个方面差异有统计学童意义(P<0.05);对上述因素进一步行多因素分析显示,年龄(χ~2=8.149,P=0.004)、发病时间(χ~2=35.687,P=0.000)、GCS评分(χ~2=40.886,P=0.000)、肺部感染(χ~2=45.413,P=0.000)为结核性脑膜炎患者出现呼吸衰竭的危险因素。对于脑脊液蛋白>1.5g/L的呼吸衰竭患者,脑脊液蛋白水平与GCS评分呈显著的负相关(P<0.01)。结论年龄、发病时间、GCS评分、肺部感染为结核性脑膜炎患者出现呼吸衰竭的危险因素。

Objective To analyze the risk factors of respiratory failure in patients with tuberculous meningitis and provide reference for patients with tuberculous meningitis.Methods A retrospective analysis of 368 cases of tuberculous meningitis in the department of thoracic hospital in the autonomous region between January 2014 to June 2017 was analyzed,and 115 cases were excluded.Among them,83 patients with respiratory failure were group A,and 83 patients with no respiratory failure were group B.The clinical data of the two groups were collected.Logistic regression analysis was performed on risk factors.Results For group A and group B the clinical data of two groups of patients with single factor analysis found that age(χ2=8.149,P=8.149),history of head injury(χ2=6.760,P=6.760),period(χ2=35.687,P=35.687),GCS score(χ2=40.886,P=40.886),and pulmonary infection(χ2=45.413,P=45.413)merger of cerebral infarction(χ2=7.000,P=7.000)statistical differences from six aspects,such as P values<0.05.Of these factors further lines of multi factor analysis showed that age(χ2=8.149,P=8.149),period(χ2=35.687,P=35.687),GCS score(χ2=40.886,P=40.886),pulmonary infection(χ2=45.413,P=45.413)for patients with tuberculous meningitis appear a risk factor for respiratory failure.There was a significant negative correlation between CSF and GCS scores in patients with cerebrospinal fluid protein greater than 1.5 g/L(P<0.01).Conclusion In this article,we found the risk factors of age,morbidity,GCS,lung infections,and respiratory failure in patients with TB meningitis.