NIHSS评分对脑卒中手术患者医院感染的预测作用

Predictive effect of NIHSS score on healthcare-associated infection in stroke patients undergoing surgery

目的探讨美国国立卫生研究院卒中量表(NIHSS)评分对脑卒中手术患者医院感染的预测效果。方法对2016年1月1日-2020年1月1日某三级甲等教学医院神经外科病房脑卒中手术患者进行前瞻性目标监测,选取符合纳入标准的患者,并填写自行设计的《脑卒中手术病人医院感染目标性监测调查表》,分析患者的一般临床特征,用卡方检验分析不同性别、年龄、卒中类型、手术频数、手术风险分级(NNIS),引流管数目和NIHSS评分患者之间医院感率有无差异,NIHSS评分与医院感染的关系,用受试者工作特征曲线(ROC)检验NIHSS评分对医院感染预测的准确度。结果本研究共纳入脑卒中手术患者983例,发生医院感染226例(22.99%);NIHSS评分0、5~15、16~20、21~42分患者均以肺部感染为主,1~4分患者以手术部位感染为主;卒中性医院感染、肺部感染、尿路感染、手术部位感染、血流感染NIHSS评分的曲线下面积分别为0.678(95%CI:0.633~0.723,P<0.001)、0.700(95%CI:0.646~0.754,P<0.001)、0.724(95%CI:0.650~0.844,P<0.001)、0.597(95%CI:0.525~0.669,P=0.008)、0.731(95%CI:0.539~0.923,P=0.017)。结论脑卒中手术患者的NIHSS评分对医院感染有显著的预测作用,对于入院时NIHSS评分较高的患者,应重点关注肺部感染情况,并采取针对性地治疗和护理措施,预防医院感染发生,降低医院感染率。

OBJECTIVE To explore the predictive effect of National Institute of Health stroke scale(NIHSS)score on healthcare-associated infection(HAI) in stroke patients undergoing surgery. METHODS Prospective target monitoring was conducted on stroke patients in Neurosurgery Department of a tertiary first-class teaching hospital from Jan 1, 2016 to Jan 1, 2020. The patients who met the inclusion criteria were enrolled and filled in the Nosocomial Infection Monitoring Questionnaire for Patients undergoing Stroke Surgery we designed. Demographic characteristics such as age, gender, types of stroke, NNIS, number of drainage tube, number of operations, NIHSS score and other information were collected. Relationship between NIHSS score and healthcare-associated infection was analyzed and the accuracy of NIHSS score in predicting HAI was analyzed by receiver operating characteristic curve(ROC). RESULTS A total of 983 stroke patients were enrolled, 226(22.99%) of whom had HAIs. Pulmonary infection occurred most frequently in patients with NIHSS score of 0, 5-15, 16-20, 21-42 groups, and surgical site infection occurred in most patients with NIHSS score 1-4. ROC curve analysis showed that the area under the curve of NIHSS score in stroke patients with HAI, pulmonary infection, urinary tract infection, surgical site infection and blood stream infection were 0.678(95% CI:0.633-0.723, P<0.001), 0.700(95% CI: 0.646-0.754,P<0.001), 0.724(95% CI: 0.650-0.844, P<0.001), 0.597(95% CI: 0.525-0.669, P=0.008), 0.731(95% CI: 0.539-0.923, P=0.017), respectively. CONCLUSION NIHSS score of stroke patients has a significant predictive effect on HAI. For patients with high NIHSS score, we should take effective measures to prevent HAIs and reduce hospital infection rate.