660例创伤患者肺部感染的危险因素分析

Analysis of risk factors of pulmonary infection in 660patients with trauma

目的:探索创伤患者肺部感染的危险因素及其对预后的影响,指导临床救治,改善疗效。方法:回顾性分析2016年1月—2018年1月期间660例创伤患者的临床资料,其中男497例,女163例。采用Logistic回归分析创伤患者肺部感染对预后(28d死亡事件)的影响及相关危险因素。结果:660例患者中,共有124例发生肺部感染(18.8%),536例未发生肺部感染(81.2%)。28d死亡病例为46例(6.96%),其中肺部感染患者35例(28.23%)显著高于非肺部感染组11例(2.05%)(P<0.01),肺部感染是创伤患者死亡的重要独立危险因素(OR=12.83,95%CI:5.70~28.89,P<0.01)。多因素Logistic回归分析提示年龄(OR=1.02,95%CI:1.01~1.03,P=0.001)、严重损伤[损伤严重程度评分(ISS)≥16](OR=6.86,95%CI:3.87~12.16,P<0.01)、胸部损伤(OR=2.54,95%CI:1.20~5.37,P=0.015)、急诊手术(OR=2.21,95%CI:1.35~3.61,P=0.002)和收入ICU(OR=2.43,95%CI:1.21~4.86,P=0.013)是创伤患者发生肺部感染的独立危险因素。结论:创伤患者发生肺部感染与年龄、ISS≥16、发生胸部损伤、接受急诊手术和入住ICU等因素密切相关,有效预防和治疗肺部感染是改善创伤患者预后的重要环节。

Objective:To explore the risk factors of pulmonary infection in trauma patients and their influence on prognosis,to guide clinical treatment and improve the curative effect.Methods:The clinical data of 660trauma patients from January 2016to January 2018were retrospectively analyzed,including 497males and 163females.Logistic regression was used to analyze the influence of lung infection in trauma patients on the prognosis(28-day death event)and related risk factors.Results:A total of 124cases(18.8%)developed pulmonary infection,while 536cases(81.2%)did not.There were 46deaths(6.96%)at 28days,of which 35(28.23%)patients with lung infection were significantly higher than 11(2.05%)in the non-pulmonary infection group(P<0.01).Pulmonary infection was an important independent risk factor of death in trauma patients(OR=12.83,95%CI:5.70-28.89,P<0.01).Multivariate Logistic regression analysis indicated that age(OR=1.02,95%CI:1.01-1.03,P=0.001),severe injury(injury severity score,ISS≥16)(OR=6.86,95%CI:3.87-12.16,P<0.01),chest injury(OR=2.54,95%CI:1.20-5.37,P=0.015),emergency surgery(OR=2.21,95%CI:1.35-3.61,P=0.002)and ICU admission(OR=2.43,95%CI:1.21-4.86,P=0.013)were the independent risk factors for pulmonary infection in trauma patients.Conclusion:Pulmonary infection in trauma patients is closely related to age,ISS≥16,occurrence of chest injury,emergency surgery,ICU admission and other factors.Effective prevention and treatment of pulmonary infection is an important link to improve the prognosis of patients with trauma.