重型颅脑外伤并发呼吸道感染的临床特征及危险因素分析

Clinical Characteristics and Risk Factors of Severe Craniocerebral Trauma Complicated with Respiratory Tract Infection

目的:分析重型颅脑外伤并发呼吸道感染的临床特征及危险因素。方法:回顾性收集某院在2016年1月~2021年1月期间收治的60例重型颅脑外伤患者的临床资料,按照相关呼吸道感染诊断标准对感染情况进行分析,利用单因素分析和多元Logistic回归分析法筛选出重型颅脑外伤并发呼吸道感染患者的危险因素。结果:60例重型颅脑外伤患者中,有14例并发呼吸道感染,占总例数的23.33%,共分离出18株病原菌,其中鲍曼溶血不定杆菌5株、铜绿假单胞菌5株、革兰氏阴性菌4株、真菌4株,分别占比27.78%、27.78%、22.22%、22.22%。单因素分析显示:患者年龄≥65岁、有吸烟史、有糖尿病、使用抗生素、使用糖皮质激素、有鼻饲、入院时GCS评分≥6分、气管切开时间≥7d、ICU入住时间≥7d是重型颅脑外伤并发呼吸道感染的相关因素(P<0.05);多元Logistic回归分析显示:患者年龄≥65岁、有吸烟史、有糖尿病、入院时GCS评分≥6分、气管切开时间≥7d、ICU入住时间≥7d是重型颅脑外伤并发呼吸道感染的危险因素(P<0.05)。结论:重型颅脑外伤并发呼吸道感染率较高,主要感染病原菌为鲍曼溶血不定杆菌、铜绿假单胞菌,其危险因素为年龄≥65岁、有吸烟史、有糖尿病、入院时GCS评分≥6分、气管切开时间≥7d、ICU入住时间≥7d,应根据患者实际情况制定针对性干预措施降低感染率。

Objective:To analyze the clinical characteristics and risk factors of severe craniocerebral trauma complicated with respiratory tract infection.Methods:The clinical data of 60 patients with severe craniocerebral trauma in a hospital from January 2016 to January 2021 were retrospectively collected.The infection was analyzed according to the relevant diagnostic criteria of respiratory tract infection.The risk factors of severe craniocerebral trauma complicated with respiratory tract infection were screened by single factor analysis and multiple logistic regression analysis.Results:Among 60 cases of severe craniocerebral trauma,14 cases were complicated with respiratory tract infection,accounting for 23.33%of the total cases.A total of 18 strains of pathogens were isolated,including 5 strains of Acinetobacter baumannii,5 strains of Pseudomonas aeruginosa,4 strains of Gram-negative bacteria and 4 strains of fungi,accounting for 27.78%,27.78%,22.22%and 22.22%respectively.Univariate analysis showed that age≥65 years old,smoking history,diabetes,use of antibiotics,use of glucocorticoids,nasal feeding,admission GCS score≥6,tracheotomy time≥7 days,ICU stay time≥7 days were the related factors of severe craniocerebral trauma complicated with respiratory tract infection(P<0.05).Multivariate logistic regression analysis showed that age≥65 years old,smoking history,diabetes mellitus,GCS score at admission≥6,tracheotomy time≥7 days,ICU stay≥7 days were risk factors of severe craniocerebral injury complicated with respiratory tract infection(P<0.05).Conclusion:The rate of severe craniocerebral trauma complicated with respiratory tract infection rate is high,the main pathogens are Acinetobacter baumannii and Pseudomonas aeruginosa,the risk factors are age≥65 years old,smoking history,diabetes,admission GCS score≥6,tracheotomy time≥7 days,ICU admission time≥7 days,and the targeted intervention measures should be formulated according to the actual situation of patients to reduce the infection rate.