颅脑外伤术后卧床患者并发坠积性肺炎的危险因素分析

Risk factors of hypostatic pneumonia in bedridden patients after craniocerebral trauma surgery

目的:分析颅脑外伤术后卧床患者并发坠积性肺炎的危险因素。方法:回顾性收集205例颅脑外伤术后卧床患者的一般资料,单因素和多因素Logistic回归分析颅脑外伤术后卧床患者并发坠积性肺炎的危险因素,并分析坠积性肺炎与患者预后的关系。结果:采集的205例颅脑外伤手术患者中,感染坠积性肺炎74例,感染率为36.10%。单因素分析结果显示,感染坠积性肺炎与未感染患者在年龄、吸烟史、合并糖尿病、格拉斯哥昏迷(GCS)评分、是否气管切开、术后是否发生低白蛋白、是否预防性地使用抗生素等方面比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄≥60岁(OR=3.554,P<0.05)、吸烟(OR=2.003,P=0.016)、合并糖尿病(OR=4.196,P<0.05)、GCS评分3~8分(OR=6.974,P<0.05)、气管切开(OR=4.032,P=0.008)、术后低白蛋白(OR=2.543,P=0.005)是引起颅脑外伤术后卧床患者并发坠积性肺炎的危险因素,预防性使用抗生素(OR=0.349,P<0.05)是颅脑外伤术后卧床患者并发坠积性肺炎的保护因素。坠积性肺炎感染患者其他并发症发生率、致残率和死亡率高于未感染患者(P<0.05)。结论:年龄≥60岁、吸烟、合并糖尿病、GCS评分3~8分、气管切开、术后低白蛋白均是引起颅脑外伤术后卧床患者并发坠积性肺炎的危险因素,临床需加以重视。

Objective:To retrospectively analyze the risk factors of hypostatic pneumonia in bedridden patients after craniocerebral trauma surgery.Methods:The general data of 205 bedridden patients with traumatic brain injury were collected retrospectively.The risk factors of bedridden patients with traumatic brain injury complicated with hypostatic pneumonia were analyzed by univariate and multivariate logistic regression,and the relationship between hypostatic pneumonia and prognosis was discussed.Results:Among 205 patients with craniocerebral trauma,74 cases were infected with hypostatic pneumonia,and the infection rate was 36.10%.Univariate analysis showed that there were significant differences in age,smoking history,diabetes mellitus,GCS score,tracheotomy,postoperative hypoalbuminemia and prophylactic use of antibiotics between the two groups(P<0.05).Multivariate logistic regression analysis showed that age≥60 years old(OR=3.554,P<0.05),smoking(OR=2.003,P=0.016),diabetes mellitus(OR=4.196,P<0.05),GCS score of 3-8(OR=6.974,P<0.05),tracheotomy(OR=4.032,P=0.008)and postoperative low albumin(OR=2.543,P=0.005)were the risk factors for postoperative bedridden patients with traumatic brain injury complicated with hypostatic pneumonia.Prophylactic use of antibiotics(OR=0.349,P<0.05)were the protective factors of hypostatic pneumonia in bedridden patients after craniocerebral trauma surgery.The incidence of other complications,disability rate and mortality rate in the infection group were higher than those in the non infection group(P<0.05).Conclusion:Age≥60 years old,smoking,diabetes mellitus,GCS score 3-8,tracheotomy,postoperative low albumin are the risk factors of post-operative bedridden patients with traumatic brain injury complicated with hypostatic pneumonia,we should pay attention to it in clinic.