颅脑外伤患者术后肺部感染的临床特点及易感因素分析

Clinical characteristics and susceptibility factors of postoperative pulmonary infection in patients with craniocerebral trauma

目的探讨颅脑外伤患者术后肺部感染的临床特点及易感因素。方法抽取2018年6月至2020年12月晋城市人民医院收治的101例颅脑外伤手术后患者作为研究对象,根据术后肺部感染发生情况分为感染组(23例)及非感染组(78例)。分析感染组患者的临床特点,采集感染组患者的痰标本,分析病原菌的分布情况,采用单因素及多因素Logistic回归模型分析颅脑外伤患者术后肺部感染的易感因素。结果23例颅脑外伤术后肺部感染患者的临床表现为咳嗽、咳痰,右肺下叶为主要病变部位,以单纯浸润性病变为主。23例颅脑外伤术后肺部感染患者共培养分离病原菌31株,其中革兰阳性菌9株(29.03%),革兰阴性菌20株(64.52%),真菌2株(6.45%)。Logistic回归分析结果显示,年龄≥60岁(OR=1.917,P=0.006)、吸烟史(OR=1.982,P=0.001)、昏迷时间>24 h(OR=2.164,P=0.004)、格拉斯哥昏迷量表评分法评分<7分(OR=2.094,P=0.001)、低蛋白血症(OR=2.217,P=0.005)、气管切开(OR=2.328,P=0.006)、住院时间≥20 d(OR=2.477,P=0.008)是脑外伤患者术后肺部感染的易感因素。结论咳嗽、咳痰是颅脑外伤术后肺部感染患者的主要临床表现,右肺下叶为主要病变部位,以单纯浸润性病变为主,主要为革兰阴性菌感染,临床需根据易感因素给予针对性干预措施。

Objective To investigate the clinical characteristics and susceptibility factors of postoperative pulmonary infection in patients with craniocerebral trauma.Methods One hundred and one patients with craniocerebral trauma treated in Jincheng People’s Hospital from June 2018 to December 2020 were enrolled as the research objects.According to occurrence of postoperative pulmonary infection,they were divided into infection group(23 cases)and non-infection group(78 cases).The clinical characteristics of patients in infection group were analyzed.The sputum samples from patients in infection group were collected to analyze the distribution and drug resistance of pathogens.The susceptibility factors of postoperative pulmonary infection were analyzed by univariate and multivariate Logistic regression models.Results The clinical manifestations of postoperative pulmonary infection in 23 patients with craniocerebral trauma included cough and expectoration.The inferior lobe of right lung was the main lesion site,most of lesions were infiltrating lesions.In 23 patients with postoperative pulmonary infection,there were 31 strains of pathogens,including 9 strains(29.03%)of Gram-positive bacteria,20 strains(64.52%)of Gram-negative bacteria and 2 strains(6.45%)of fungi.The results of Logistic regression analysis showed that age≥60 years(OR=1.917,P=0.006),smoking history(OR=1.982,P=0.001),coma time>24 h(OR=2.164,P=0.004),Glasgow coma scale score<7(OR=2.094,P=0.001),hypoproteinemia(OR=2.217,P=0.005),tracheotomy(OR=2.328,P=0.006)and hospital stay≥20 d(OR=2.477,P=0.008)were all susceptibility factors of postoperative pulmonary infection.Conclusions The main clinical manifestations in patients with pulmonary infection include cough and expectoration.The inferior lobe of right lung is the main lesion site,infiltrating lesions is the manin type.The main pathogen is Gram-negative bacteria.Clinically,targeted interventions should be given based on susceptibility factors.