脑出血术后肺部感染相关因素及以时机理论为框架的持续性护理效果观察

Analysis of the factors influencing postoperative pulmonary infection in the patients with cerebral hemorrhage and effects of timing theory⁃based continuous nursing

目的探究脑出血术后引起肺部感染的相关因素及以时机理论为框架的持续性护理预防效果观察。方法回顾性分析2020年3月至2021年9月联勤保障部队第九〇四医院收治的124例急性脑出血行手术治疗的患者临床资料。根据其术后肺部感染情况分为感染组(58例)和非感染组(66例),分析脑出血术后引起肺部感染的单因素,并采用多因素Logistic回归分析探究脑出血术后引起肺部感染的危险因素。感染组患者采用以时机理论为框架的持续性护理,并观察护理效果。结果单因素分析显示,2组患者在年龄、抗生素使用情况、呼吸机使用情况、吸入性肺炎、脑出血量、手术方式、格拉斯哥评分、入院时美国国立卫生研究院卒中量表(NIHSS)及入院时日常生活能力量表(ADL)方面比较差异有统计学意义(P<0.05);多因素分析显示,年龄≥60岁、使用抗生素3种及以上、使用呼吸机超过2 d、吸入性肺炎、格拉斯哥评分≤6分是脑出血术后引起肺部感染的独立危险因素(P<0.05)。护理后,感染组患者脑血肿量<30 ml占75.86%(44/58),NIHSS评分减少至(11.10±4.23)分,ADL评分升高至(26.21±5.44)分,肺部感染好转率占93.10%(54/58)。结论使用抗生素3种及以上、使用呼吸机超过2 d、吸入性肺炎、年龄≥60岁及格拉斯哥评分≤6分是脑出血术后引起肺部感染的独立危险因素。采用以时机理论为框架的持续性护理能有效改善患者脑血肿、神经缺损及肺部感染情况,还能提高其日常生活能力。

Objective To explore the influencing factors of postoperative pulmonary infection in the patients with cerebral hemorrhage,and also to observe the effects of timing theory⁃based continuous nursing.Methods One hundred and twenty⁃four patients with acute cerebral hemorrhage who underwent surgery in the Neurosurgery Department of the Hospital from March 2020 to September 2021 were retrospectively analyzed.The patients were divided into the pulmonary infection group(n=58)and the nonpulmonary infection group(n=66),depending on pulmonary infection after surgery.The clinical data of all the subjects were collected,then univariate and multivariate Logistic regression analyses were performed to find out the factors affecting postoperative pulmonary infection in the patients with cerebral hemorrhage.The patients in the infection group was given timing theory⁃based continuous nursing,and the nursing effects was observed closely.Results Univariate analysis indicated that there was statistical significance in age,antibiotic medication,mechanical ventilation,aspiration pneumonia,cerebral hemorrhage volume,surgical method,Glasgow scores,the scores of National Institutes of Health stroke scale(NIHSS)and the activities of daily life scale(ADL)at admission,when comparisons were made between the 2 group(P<0.05).Multivariate results revealed that age≥60 years old,medication with three or more antibiotics,duration of mechanical ventilation for over 2 days,aspiration pneumonia,and Glasgow scores≤6 were all independent risk factors for postoperative pulmonary infection in the patients with cerebral hemorrhage(P<0.05).After nursing intervention in the patients of the infection group,the percentage of the patients with a cerebral hemorrhage volume<30 ml was 75.86%(44/58),The NIHSS scores decreased to(11.10±4.23),the ADL scores increased to(26.21±5.44)and the improvement rate of pulmonary infection was 93.10%(54/58).Conclusion Medication with three or more antibiotics,duration of mechanical ventilation for over 2 days,aspiration pneumonia,age≥60 years and Glasgow scores≤6 are all independent risk factors of postoperative pulmonary infection in the patients with cerebral hemorrhage.The application of timing theory⁃based continuous nursing could effectively alleviate cerebral hematoma,neurological deficits and pulmonary infections,and at the same time improve daily life activities of the patients.