幕上自发性脑出血并发医院获得性肺部感染的独立危险因素分析

Independent Risk Factors Analysis of Nosocomial Pulmonary Infection Subsequent to Supratentorial Spontaneous Intracerebral Hemorrhage

目的探讨幕上自发性脑出血(sICH)患者并发医院获得性肺部感染(HAP)的独立危险因素,以识别临床中并发HAP的高危患者。方法依照入组标准选取2014年1月-2020年3月发病的1023例幕上sICH患者,并纳入"自发性脑出血患者早期危险分层与提前外科干预策略的多中心前瞻性队列研究(Risa-MIS-ICH)"的回顾性队列。通过检索院内病历系统,收集HAP发生情况、人口学、影像学等信息,根据诊断标准,以是否发生HAP作为结局进行分组,采用单因素分析和多因素二元logistic回归分析院内并发HAP的独立危险因素。结果单因素分析结果显示,男性、(更短的)发病至入院时长、体温升高、脉搏增快、意识障碍等18项指标在两组间差别有统计学意义(P<0.05)。多因素logistic回归分析提示,男性(OR=1.607,95%CI:1.031~2.504,P=0.036)、意识障碍(GCS 9~12分vs 13~15分:OR=15.122,95%CI:4.400~51.973,P<0.001;GCS 3~8分vs 13~15分:OR=18.504,95%CI:5.201~65.831,P<0.001)、生活功能障碍(mRS评分:OR=1.618,95%CI:1.259~2.081,P<0.001)、药物降颅压治疗(OR=2.216,95%CI:1.160~4.237,P=0.016)、采用外科手术治疗(OR=2.445,95%CI:1.351~4.427,P=0.003)是幕上sICH患者并发HAP的独立危险因素(P<0.05)。结论男性、意识障碍、生活功能障碍、采用药物降颅压治疗及外科手术治疗是幕上sICH患者并发HAP的独立危险因素,对此类患者应进行重点监测,以便及早诊治,改善相关预后。

Objective To explore the independent risk factors of nosocomial pulmonary infection(hospital-acquired pneumonia, HAP) subsequent to supratentorial spontaneous intracerebral hemorrhage(sICH) and identify high-risk individuals of complicating HAP. Methods 1 023 individuals diagnosed with supratentorial sICH between January 2014 and March 2020 were retrospectively reviewed and enrolled for “Risk Stratification and Minimally Invasive Surgery in Acute Intracerebral Hemorrhage Patients-a Prospective Multicenter Cohort Study(Risa-MIS-ICH study)”. HAP was considered as the primary outcome and basis of study grouping. Clinical indicators(HAP, demographic characteristics, imaging features, etc.) were collected for univariable tests, and significant factors would be further enrolled for multivariable Logistic analysis. Results Univariable tests revealed 18 indicators(male gender, the shorter interval from onset to admission, higher temperature, rapid pulse, disturbance of consciousness, and massive intracerebral parenchymal hemorrhage, etc.) contributing to HAP events with significance(P<0.05). Further multivariable Logistic analysis indicated that only 5 risk factors remain independent significant(P<0.05), including male gender(OR=1.607, 95%CI: 1.031-2.504, P=0.036), disturbance of consciousness(GCS=9-12 vs 13-15: OR=15.122, 95%CI: 4.400-51.973, P<0.001;GCS=3-8 vs 13-15: OR=18.504, 95%CI: 5.201-65.831, P<0.001), impaired living function(mRS: OR=1.618, 95%CI: 1.259-2.081, P<0.001), reducing intracranial pressure(ICP) medication(OR=2.216, 95%CI: 1.160-4.237, P=0.016), and therapeutic neurosurgical approach(OR=2.445, 95%CI: 1.351-4.427, P=0.003). Conclusions Male gender, disturbance of consciousness, impaired living function, reducing ICP medication, and therapeutic neurosurgical approach are reliable independent risk factors to predict HAP events, which may be applied to achieve early diagnosis, dosing, and further relevant prognosis improvement in high-risk individuals.