GCS评分对脑卒中手术患者医院感染的预测效果

Predictive effect of Glasgow Coma Scale score on healthcare-associated infection in stroke patients undergoing surgery

目的探讨GCS评分对脑卒中手术患者医院感染的预测效果,为临床医务人员采取有效的预防措施提供科学依据。方法 选取2016年1月1日—2018年12月31日某三级甲等教学医院神经外科病房脑卒中手术患者作为研究对象,进行前瞻性目标监测,采用自行设计的调查表收集患者人口学特征、临床特征资料,比较患者临床差异性,应用ROC曲线检验GCS评分对患者医院感染的预测准确度。结果 共纳入816例脑卒中手术患者,发生医院感染213例,医院感染率为26.10%。随着GCS评分的降低,患者医院感染率呈上升趋势;GCS评分>9分的患者以肺部感染、手术部位感染最多见,GCS评分为3~8分者以肺部感染、多部位感染为主。ROC曲线分析结果显示,卒中性医院感染、肺部感染、尿路感染、手术部位感染、血流感染GCS评分的曲线下面积分别为0.747(95%CI:0.707~0.786)、0.799(95%CI:0.759~0.838)、0.789(95%CI:0.722~0.856)、0.565(95%CI:0.492~0.638)、0.730(95%CI:0.509~0.952),且差异均有统计学意义(均P<0.05)。结论 脑卒中手术患者GCS评分对医院感染的预测作用显著,对于GCS评分较低的高风险患者,应采取有效的感染预防措施,降低感染发生率。

Objective To explore the predictive effect of Glasgow Coma Scale (GCS) score on healthcare-associa-ted infection(HAI) in stroke patients undergoing surgery, and provide scientific basis for health care worker to take effective preventive measures. Methods Stroke patients who underwent surgery in the neurosurgery ward of a tertiary first-class teaching hospital from January 1, 2016 to December 31, 2018 were conducted prospective targeted surveillance , a self-designed questionnaire was used to collect patients’ demographic and clinical data, clinical diffe -rences among patients were compared;accuracy of GCS in predicting HAI was tested by receiver operating characte - ristic curve (ROC curve). Results A total of 816 stroke patients were enrolled in study, 213 (26.10%) of whom had HAI, with the decrease of GCS score, HAI rate of patients showed an upward trend;pulmonary infection and surgical site infection were the most common in patients with GCS score>9, and pulmonary infection and multi-site infection were most common in patients with GCS score of 3-8. ROC curve analysis showed that area under curve of GCS score of stroke HAI, pulmonary infection, urinary tract infection, surgical site infection, and blood stream infection were 0.747 (95% CI : 0.707-0.786), 0.799 (95% CI : 0.759-0.838), 0.789 (95% CI : 0.722- 0.856 ), 0.565 (95% CI : 0.492-0.638), and 0.730 (95% CI : 0.509-0.952) respectively, with significant differences (all P <0.05). Conclusion GCS score of stroke patients has a significant predictive effect on HAI, for high-risk patients with low GCS score, effective infection prevention measures should be taken to reduce the incidence of infection.