癫痫持续状态患者肺部感染相关因素分析

Analysis of related factors of pulmonary infection in patients with status epilepticus

目的:探讨癫痫持续状态(status epilepticus,SE)患者合并肺部感染的相关因素。方法:回顾性分析2012-07-01~2018-09-30我院收治的SE患者1856例的临床资料,分析临床因素与SE合并肺部感染的相关性。结果:1856例SE患者中发生肺部感染者167例,发生率为9.00%。单因素分析显示,有合并症、持续发作时间≥2 h、发作次数≥3次/d、昏迷、呕吐、癫痫持续状态严重程度评分量表(status epilepticus severity score,STESS)评分>3分、抽搐、误吸、持续性发作、气管插管、血氧饱和度<90%均是SE肺部感染的相关危险因素(P<0.05);发作开始至起始用抗癫痫药物(antiepileptic drugs,AEDs)时间<1 h、口腔护理是SE肺部感染的相关保护因素(P<0.05)。Logistic回归分析显示,持续发作时间≥2 h、发作次数≥3/d、STESS评分>3分、误吸等是SE肺部感染的独立危险因素(P<0.05),发作开始至起始用AEDs时间<1 h、口腔护理是SE肺部感染的独立保护性因素(P<0.05)。结论:SE合并肺部感染与多因素相关,早期使用AEDs、减少发作时间和次数、防止误吸、重点关注STESS评分高的患者,加强口腔护理等为主的综合措施,可降低SE肺部感染发生率。

Objective:To investigate the related factors of pulmonary infection in patients with status epilepticus(SE).Methods:The clinical data of 1856 patients with SE from July 2012 to September 2018 were retrospectively analyzed.The correlation between clinical factors and SE with pulmonary infection was analyzed.Results:A total of 167 patients with pulmonary infection occurred in 1856 patients with persistent epilepsy.The incidence of pulmonary infection was 9.00%.Univariate analysis showed that comorbidity,duration of onset≥2 h,number of episodes≥3/d,coma,vomiting,status epilepticus severity score(STESS)>3,convulsions,aspiration,persistent seizures,endotracheal intubation and oxygen saturation<90%were risk factors for SE lung infection(P<0.05).The time from onset to initial antiepileptic drugs(AEDs)<1 h and oral care were related protective factors for SE lung infection(P<0.05).Logistic regression analysis showed that duration of attack≥2 h,number of episodes≥3/d,TESS score>3 and aspiration were independent risk factors for SE lung infection(P<0.05),and the time from onset to initiation of AEDs<1 h and oral care were independent protective factors for SE lung infection(P<0.05).Conclusion:The status of SE with pulmonary infection is associated with multiple factors.Early use of AEDs,reduction of time and number of episodes,prevention of aspiration,focus on patients with high TESS scores,and enhanced oral care can reduce the incidence rate of lung infections in patients with SE.