神经外科介入治疗术后患者发生肺部感染的影响因素分析

Analysis of risk factors for pulmonary infection in patients after neurointerventional therapy

目的探讨神经外科介入治疗术后患者发生肺部感染的影响因素。方法回顾性连续纳入2016年1—12月入住首都医科大学宣武医院神经外科行介入治疗的患者1274例,根据介入治疗术后是否发生肺部感染,将其分为肺部感染组(29例)和无肺部感染组(1245例)。收集患者基线资料、实验室检查结果、治疗情况等,并进行组间比较。基线资料包括年龄、性别、呼吸病史等;实验室检查资料包括肝肾功能等;治疗情况包括机械通气、输血、低温治疗及静脉置管等。以发生肺部感染为因变量,纳入单因素分析差异有统计学意义(P<0.01)的参数进一步行神经外科介入治疗术后患者发生肺部感染影响因素的多因素Logistic回归分析。结果(1)神经外科介入治疗患者肺部感染发生率为2.3%(29/1274)。肺部感染组患者年龄及机械通气、呼吸系统疾病、低温治疗、输血、静脉置管比例均高于无肺部感染组,组间差异均有统计学意义[(61±17)岁比(53±17)岁,t=2.480;86.2%(25/29)比3.9%(49/1245),χ2=350.606;6.9%(2/29)比1.6%(20/1245),χ2=4.674;31.0%(9/29)比0.7%(9/1245),χ2=18.936;41.4%(12/29)比0.9%(11/1245),χ2=262.163;89.7%(26/29)比5.0%(62/1245),χ2=315.997;均P<0.05]。性别、院前呕吐、肝功能异常、肾功能异常的组间差异均无统计学意义(均P>0.05)。(2)多因素Logistic回归分析结果显示,机械通气、输血、静脉置管是神经外科介入治疗患者发生肺部感染的独立危险因素(OR=9.110,95%CI:1.587~52.310,P=0.0132;OR=8.838,95%CI:2.546~30.684,P=0.0006;OR=21.772,95%CI:3.316~142.951,P=0.0013),低温治疗非神经介入术后患者发生肺部感染的影响因素(P>0.05)。结论机械通气、输血、静脉置管可增加神经外科介入治疗患者发生肺部感染的风险,对该类患者应高度重视。

Objective To investigate the risk factors of pulmonary infection in patients after neurointerventional therapy.Methods From January to December 2016,a total of 1274 admitted patients after neurointerventional therapy in the Department of Neurosurgery of Xuanwu Hospital,Capital Medical University were retrospectively recruited.According to occurrence of pulmonary infection after neuro interventional therapy,patients were divided into pulmonary infection group(29 cases)and non-pulmonary infection group(1245 cases).Baseline data,laboratory examinations,treatment conditions,etc.,were collected and compared between groups.Baseline data include age,gender,respiratory history,etc.;laboratory examinations include liver and kidney function,etc.;treatment conditions include mechanical ventilation,blood transfusion,hypothermia treatment,intravenous catheterization,etc..Taking the occurrence of pulmonary infection as the dependent variable,parameters with statistically significant difference(P<0.01)in the univariate analysis were further recruited into multivariate Logistic regression analysis to explore the influencing factors of pulmonary infection in patients after neurointerventional therapy.Results(1)Pulmonary infection occurrence rate was 2.3%(29/1274).In the pulmonary infection group,the proportion of age,mechanical ventilation,respiratory diseases,hypothermia treatment,blood transfusion,and intravenous catheterization was respectively higher than that in the non-pulmonary infection group,with statistically significant differences([61±17]years old vs.[53±17]years old,t=2.480;86.2%[25/29]to 3.9%[49/1245],χ2=350.606;6.9%[2/29]vs.1.6%[20/1245],χ2=4.674;31.0%[9/29]vs.0.7%[9/1245],χ2=18.936;41.4%[12/29]vs.0.9%[11/1245],χ2=262.163;89.7%[26/29]vs.5.0%[62/1245],χ2=315.997;all P<0.05).There were no statistically significant differences in gender,pre-admission vomiting,abnormal liver function or renal function between groups(all P>0.05).(2)Logistic multiple regression results showed that mechanical ventilation,blood transfusion,and venous catheterization were independent risk factors for pulmonary infection in patients after neurointerventional therapy(OR,9.110,95%CI 1.587-52.310,P=0.0132;OR,8.838,95%CI 2.546-30.684,P=0.0006;OR,21.772,95%CI 3.316-142.951,P=0.0013).Hypothermia treatment was not the risk factor for pulmonary infection in patients after neurointerventional therapy(P>0.05).Conclusions Mechanical ventilation,blood transfusion,and venous catheterization can increase the risk of pulmonary infection in patients after neurointerventional therapy.This type of patients should be paid more attention.