高血压脑出血患者术后发生肺炎的影响因素分析

Analysis of influencing factors of postoperative pneumonia in patients with hypertensive intracerebral hemorrhage

目的探讨高血压脑出血(HICH)患者术后肺炎发生率及其相关影响因素,并提出防治措施。方法选取2018年6月至2020年12月浙江省诸暨市人民医院收治的239例HICH手术患者,依据其住院期间是否发生肺炎分为肺炎组(n=63)和非肺炎组(n=176);比较两组患者的年龄、性别、体质量指数、冠心病、糖尿病、肺部基础疾病、意识障碍、吞咽困难、血肿体积、NIHSS评分、低蛋白血症、PCT、鼻饲治疗、侵入性气道操作、应用糖皮质激素、应用抗生素、使用抑酸制剂等;然后采用逐步logistic回归法进行危险因素筛选。结果239例HICH患者术后肺炎发生率26.36%(63/239);多因素logistic回归结果显示,影响HICH患者术后发生肺炎的危险因素有高龄(OR=3.025)、糖尿病(OR=3.725)、肺部基础疾病(OR=2.883)、吞咽困难(OR=4.540)、入院NIHSS评分(OR=3.476)、低蛋白血症(OR=2.989)、PCT(OR=5.254)、侵入性气道操作(OR=3.896)。结论HICH患者术后肺炎发生率较高,应引起高度重视,针对以上高危因素,早期实施防治措施,降低肺炎发生率,改善HICH患者的预后。

Objective To explore the incidence of postoperative pneumonia in patients with hypertensive intracerebral hemorrhage(HICH)and its related influencing factors,and put forward preventive measures.Methods A total of 239 patients undergoing HICH operation in Zhuji People’s Hospital in Zhejiang Province from June 2018 to December 2020 were selected and divided into the pneumonia group(n=63)and the non-pneumonia group(n=176)according to whether pneumonia occurred during hospitalization.The age,gender,body mass index,coronary heart disease,diabetes mellitus,basic pulmonary diseases,disturbance of consciousness,dysphagia,hematoma volume,NIHSS score,hypoproteinemia,PCT,nasal feeding treatment,invasive airway operation,glucocorticoid,antibiotics and acid inhibitor were compared between the two groups.Then the risk factors were screened by stepwise Logistic regression.Results The incidence of postoperative pneumonia in 239 HICH patients was 26.36%(63/239).The results of multivariate logistic regression showed that the risk factors of postoperative pneumonia in HICH patients included advanced age(OR=3.025),diabetes mellitus(OR=3.725),basic pulmonary diseases(OR=2.883),dysphagia(OR=4.540),NIHSS score on admission(OR=3.476),hypoproteinemia(OR=2.989),PCT(OR=5.254)and invasive airway operation(OR=3.896),etc.Conclusion The incidence of postoperative pneumonia in HICH patients is high,which should be paid great attention to.In view of the above high-risk factors,early preventive measures should be taken to reduce the incidence of pneumonia and improve the prognosis of HICH patients.