非手术的基底节区脑出血患者急性期医院内感染的相关因素分析

Analysis of the related factors of nosocomial infection in patients with non-surgical basal ganglia intracranial hemorrhage in acute phase

目的评估非手术的基底节区脑出血(ICH)患者急性期发生医院内感染的相关危险因素,为预防及干预措施的采取提供依据。方法将2014年1月至2018年12月收入深圳市人民医院的224例非手术的基底节区ICH患者的临床资料进行分析。根据患者是否存在感染分成两组并进行临床资料的比较,包括性别、年龄、既往病史、出血量、血肿增长速度、收缩压、舒张压、格拉斯哥昏迷指数(GCS)、美国国立卫生研究院卒中量表(NIHSS)、白细胞(WBC)、红细胞(RBC)、纤维蛋白原(FBI)、血小板(PLT)、肌酐(CR)、尿素氮(BUN)、空腹血糖(GLU)、超敏C反应蛋白(CRP)、血尿酸(UA)、总胆固醇(CHOL)、三酰甘油(TG)、低密度脂蛋白(LDL)、高同型半胱氨酸(HCY)。然后将有意义的变量(P<0.05)进行多因素Logistic回归分析及计算受试者工作特征(ROC)曲线下面积,从而判断医院内感染的早期独立预测危险因素。结果224例患者中发生医院内感染47例,感染发生率为20.98%(47/224)。与非感染组相比,感染组患者的年龄[(63.91±12.37)岁比(58.66±12.37)岁,P=0.010]、出血量[(10.33±7.94)ml比(7.61±6.58)ml,P=0.034]、血肿的增长速度[(7.34±9.17)ml/h比(4.33±6.77)ml/h,P=0.040]、收缩压[(177.94±25.28)mmHg(1 mmHg=0.133 kPa)比(164.85±22.34)mmHg,P=0.001]、NIHSS评分[(7.89±4.92)分比(4.84±4.59)分,P<0.01]、WBC[(9.50±3.23)×10^9/L比(8.25±2.28)×109/L,P=0.015]、FBI[(3.44±0.95)g/L比(3.03±0.63)g/L,P=0.007]、BUN[(7.01±5.84)mmol/L比(4.95±1.93)mmol/L,P=0.021]、GLU[(7.27±2.84)mmol/L比(5.96±1.75)mmol/L,P=0.004]、CRP[(11.94±21.4)mg/L比(4.39±6.41)mg/L,P=0.021]均明显增高。多因素Logistic回归分析显示收缩压(OR=1.021,95%CI 1.005~1.037,P=0.012)、NIHSS评分(OR=1.143,95%CI 1.056~1.237,P=0.001)、BUN(OR=1.174,95%CI 1.025~1.344,P=0.020)、CRP(OR=1.063,95%CI 1.016~1.112,P=0.008)、年龄(OR=1.053,95%CI 1.019~1.089,P=0.002)是非手术的基底节区ICH患者急性期发生医院内感染的独立危险因素。进一步计算以上独立危险因素的ROC曲线下面积结果显示收缩压(面积=0.653,95%CI 0.564~0.741,P=0.001)、NIHSS评分(面积=0.679,95%CI 0.592~0.767,P=0.000)、BUN(面积=0.617,95%CI 0.526~0.708,P=0.014)、CRP(面积=0.691,95%CI 0.614~0.768,P=0.000)、年龄(面积=0.643,95%CI 0.557~0.728,P=0.003)对非手术的基底节区ICH患者急性期医院内感染的发生具有早期的预测价值。结论非手术的基底节区ICH患者急性期发生医院内感染具有可识别的、早期预测能力的危险因素,控制其可控的危险因素可以降低医院内感染的发生率。

Objective To assess the risk factors associated with nosocomial infection in patients with non-surgical basal ganglia intracranial hemorrhage(ICH)in the acute phase to provide evidence for prevention and intervention of nosocomial infections.Methods Clinical data of 224 patients with non-surgical basal ganglia ICH from January 2014 to December 2018 in the Shenzhen People′s Hospital were analyzed.Patients were divided into 2 groups based on the presence or absence of infection.Clinical data between the two groups were compared including gender,age,past medical history,bleeding volume,hematoma growth rate,systolic blood pressure,diastolic blood pressure,GCS,NIHSS,WBC,RBC,FBI,PLT,CR,BUN,GLU,CRP,UA,CHOL,TG,LDL,HCY.Multivariate Logistic regression analysis and the area under the ROC curve were performed on meaningful variables(P<0.05)to determine the early independent predictors of risk factors for nosocomial infections.ResuIts Nosocomial infection occurred in 47 of 224 patients,with an infection rate of 20.98%.Compared with infected group,non-infected group had a higher value of age[(63.91±12.37)years vs.(58.66±12.37)years,P=0.010],bleeding volume[(10.33±7.94)ml vs.(7.61±6.58)ml,P=0.034],hematoma growth rate[(7.34±9.17)ml/h vs.(4.33±6.77)ml/h,P=0.040],systolic blood pressure[(177.94±25.28)mmHg(1 mmHg=0.133 kPa)vs.(164.85±22.34)mmHg,P=0.001],NIHSS score[(7.89±4.92)scores vs.(4.84±4.59)scores,P<0.01],WBC[(9.50±3.23)×109/L vs.(8.25±2.28)×109/L,P=0.015],FBI[(3.44±0.95)g/L vs.(3.03±0.63)g/L,P=0.007],BUN[(7.01±5.84)mmol/L vs.(4.95±1.93)mmol/L,P=0.021],GLU[(7.27±2.84)mmol/L vs.(5.96±1.75),P=0.004]and CRP[(11.94±21.4)mg/L vs.(4.39±6.41)mg/L,P=0.021].Multivariate Logistic regression analysis showed that systolic blood pressure(OR=1.021,95%CI 1.005-1.037,P=0.012),NIHSS score(OR=1.143,95%CI 1.056-1.237,P=0.001),BUN(OR=1.174,95%CI 1.025-1.344,P=0.020),CRP(OR=1.063,95%CI 1.016-1.112,P=0.008)and age(OR=1.053,95%CI 1.019-1.089,P=0.002)was an independent risk factor for nosocomial infection in non-surgical basal ganglia ICH patients in the acute phase.The Area Under Curve(AUC)of the above independent risk factors was calculated,and the results showed that systolic blood pressure(AUC=0.653,95%CI 0.564-0.741,P=0.001),NIHSS score(AUC=0.679,95%CI 0.592-0.767,P=0.000),BUN(AUC=0.617,95%CI 0.526-0.708,P=0.014),CRP(AUC=0.691,95%CI 0.614-0.768,P=0.000)and age(AUC=0.643,95%CI 0.557-0.728,P=0.003)had an early predictive value for the occurrence of nosocomial infection in non-operative basal ganglia ICH patients in the acute stage.Conclusions The occurrence of nosocomial infections has identifiable and early predictive risk factors in patients with non-surgical basal ganglia ICH during acute phase.Therefore,controllable risk factors need to be controlled to reduce the incidence of nosocomial infections.