重型颅脑损伤患者气管切开术后肺部感染特征及危险因素分析

Analysis of Characteristics and Risk Factors of Pulmonary Infection after Tracheotomy in Patients with Severe Craniocerebral Injury

目的:分析重型颅脑损伤患者气管切开术后肺部感染特征及危险因素,为干预治疗提供依据。方法:选取2018年9月—2020年12月焦作市第五人民医院收治的86例重型颅脑损伤并行气管切开术后肺部感染的患者作为感染组,并以1:1配比选取同期86例重型颅脑损伤并行气管切开术后未发生肺部感染患者作为非感染组。采用自制调查问卷收集两组性别、年龄、格拉斯哥昏迷指数(GCS)评分、长期吸烟史、低蛋白血症、糖尿病史、气管切开、慢性阻塞性肺疾病(COPD)史等信息,分析重型颅脑损伤患者气管切开术后肺部感染特征及危险因素。结果:86例肺部感染患者经病原菌培养后,共检出病原菌94株,其中革兰阴性菌68株(72.34%),革兰阳性菌19株(20.21%),真菌7株(7.45%);年龄、GCS评分、长期吸烟史、低蛋白血症、糖尿病史、气管切开、COPD史是重型颅脑损伤患者气管切开术后肺部感染的影响因素(χ^(2)=4.864、6.772、6.385、14.363、6.977、9.170、5.316,P<0.05);logistic回归分析显示,年龄>65岁、GCS≤8分、存在长期吸烟史、存在低蛋白血症、存在糖尿病史、气管切开、存在COPD史是重型颅脑损伤患者气管切开术后肺部感染危险因素,差异有统计学意义(OR=2.408、2.933、3.767、4.044、3.666、2.678、3.368,P<0.05)。结论:重型颅脑损伤患者气管切开术后肺部感染病原菌以革兰阴性菌为主,且发生肺部感染的危险因素较多,临床可根据研究结果进行对症干预治疗。

Objective:To analyze the characteristics and risk factors of pulmonary infections after tracheotomy in patients with severe craniocerebral injury and to provide a basis for interventional treatment.Methods:86 patients with pulmonary infection after heavy craniocerebral injury with tracheotomy admitted to the hospital from September 2018 to December 2020 were selected as the infected group,and 86 patients without pulmonary infection after heavy craniocerebral injury with tracheotomy in the same period were selected in a 1:1 ratio as the non-infected group.A self-administered questionnaire was used to collect information on gender,age,Glasgow Coma Scale(GCS)score,long-term smoking history,hypoproteinemia,history of diabetes mellitus,tracheotomy,and history of chronic obstructive pulmonary disease(COPD)in both groups to analyze the characteristics and risk factors of pulmonary infection after tracheotomy in patients with heavy craniocerebral injury.Results:After 86 patients with pulmonary infections were cultured for pathogenic bacteria,a total of 94 strains were detected,including 68 Gram-negative(72.34%),19 Gram-positive(20.21%)and 7 fungal(7.45%)strains.Age,GCS score,history of long-term smoking,hypoproteinemia,history of diabetes mellitus,tracheotomy,and history of COPD were factors influencing pulmonary infection after tracheotomy in patients with severe craniocerebral injury(χ^(2)=4.864,6.772,6.385,14.363,6.977,9.170,5.316,P<0.05).Logistic regression analysis showed that age>65 years,GCS≤8 points,presence of long-term smoking history,presence of hypoproteinemia,presence of diabetes mellitus,tracheotomy,and presence of COPD history were risk factors for pulmonary infection after tracheotomy in patients with heavy craniocerebral injury,with statistically significant differences(OR=2.408,2.933,3.767,4.044,3.666,2.678,3.368,P<0.05).Conclusion:The pathogenic bacteria of pulmonary infection after tracheotomy in patients with severe craniocerebral injury are mainly gram-negative bacteria,and there are more risk factors for the occurrence of pulmonary infection,and the clinical can be treated with symptomatic interventions according to the results of the study.