人工气道建立时机对重型颅脑损伤患者肺部感染的影响及相关因素

Influence and related influencing factors of artificical airway timing on pulmonary infection in patients with severe craniocerebral injury

目的探讨人工气道建立时机对重型颅脑损伤患者肺部感染的影响及肺部感染的危险因素。方法选取2015年1月至2017年12月中国人民解故军联勒保障部队第九二二医院收治的110例重型颅脑损伤伴肺部感染者的临床资料进行回顾性分析,按建立人工气道时机将入选患者分为观察组(伤后24 h内建立人工气道,共64例)与对照组(伤后24 h后建立人工气道,共46例)。比较两组患者肺部感染发生率、感染控制率、感染控制时间、病死率,分析重型颅脑损伤患者肺部感染的影响因素,行单因素分析[性别、年龄、昏迷时间、吸烟史、慢性阻塞性肺疾病(COPD)、GCS评分、建立人工气道时机、激素使用时间、抗菌药物使用时间]后行多因素Logistic回归分析。结果观察组患者肺部感染发生率显著低于对照组(40.63%vs. 60.87%,χ~2=4.389、P=0.036);感染控制率显著高于对照组(80.77%vs. 53.77%,χ~2=4.488、P=0.034);感染控制时间显著短于对照组[(7.06±2.77)d vs.(11.12±3.62)d,t=3.815、P=0.001];病死率显著低于对照组(7.81%vs. 21.74%,χ~2=4.408、P=0.036),差异均有统计学意义。性别、激素使用时间、抗菌药物使用时间对重型颅脑损伤的肺部感染无显著影响,差异均无统计学意义(χ~2=0.294、P=0.587,χ~2=0.878、P=0.349,χ~2=0.572、P=0.449)。年龄> 60岁、昏迷时间> 1周、有吸烟史、合并COPD、GCS评分≤5分、伤后24 h后建立人工气道患者的肺部感染率显著更高,差异均有统计学意义(χ~2=5.583、P=0.018,χ~2=7.328、P=0.007,χ~2=4.994、P=0.025,χ~2=4.878、P=0.027,χ~2=6.114、P=0.013,χ~2=4.389、P=0.036)。多因素Logistic分析显示,年龄> 60岁、昏迷时间> 1周、合并COPD、GCS评分≤5分、伤后24 h后建立人工气道均为重型颅脑损伤患者并发肺部感染的危险因素(P=0.024、0.015、0.019、0.007、0.011)。结论伤后24 h后建立人工气道是重型颅脑损伤患者并发肺部感染的危险因素。

Objective To investigate the influence of artificial airway on pulmonary infection in patients with severe craniocerebral injury and the risk factors of pulmonary infection.Methods From January 2015 to December 2017,a total of 110 cases of severe craniocerebral injury with pulmonary infection were analyzed, retrospectively.According to the time of establishing artificial airway,the patients were divided into observation group (64 cases) and control group (46 cases).The incidence of pulmonary infection,the time of infection control,the fatality rate,and influencing factors of pulmonary infection in patients with severe craniocerebral injury were compared,and univariate analysis was carried out [sex,age,coma time,smoking history,chronic bstructive pulmonary diseases (COPD),GCS score for chronic obstructive pulmonary disease,time to establish artificial airway,time to use hormones,time to use antibiotics],and then multivariate Logistic regression analysis was carried out.Results The incidence of pulmonary infection in the observation group was significantly lower than that of the control group (40.63% vs.60.87%;χ^2 = 4.389,P = 0.036);the infection control rate was significantly higher than that of the control group (80.77% vs.53.77%;χ^2 = 4.488,P = 0.034);the control time of infection was significantly shorter than that of the control group [(7.06 ± 2.77) d vs.(11.12 ± 3.62) d;t = 3.815, P = 0.001];the mortality was significantly lower than that of the control group (7.81% vs.21.74%;χ^2 = 4.408, P = 0.036),all with significant differences.Sex,time of hormone use and time of antimicrobial agents use had no significant effect on pulmonary infection of patients with severe craniocerebral injury,with no significant difference (χ^2 = 0.294,P = 0.587;χ^2 = 0.878,P = 0.349;χ^2 = 0.572,P = 0.449).For patients with age > 60 years old,coma period > 1 week,smoking history,COPD,GCS score ≤ 5,artificial airway established 24 hours after injury,the pulmonary infection rate were significantly higher,with statistically significant differences (χ^2 = 5.583,P = 0.018;χ^2 = 7.328,P = 0.007;χ^2 = 4.994,P = 0.025;χ^2 = 4.878,P = 0.027;χ^2 = 6.114,P = 0.013;χ^2 = 4.389,P = 0.036).Multivariate Logistic analysis showed that,age > 60 years old,coma period > 1 week, complicated with COPD,GCS score ≤ 5,artificial airway established 24 hours after injury were all the risk factors of pulmonary infection in patients with severe craniocerebral injury (P = 0.024,0.015,0.019,0.007, 0.011).Conclusion The establishment of artificial airway 24 hours after injury is a risk factor of pulmonary infection for patients with severe craniocerebral injury.