床旁超声引导留置鼻肠管技术下脑出血患者肺部感染转归的影响因素

Factors influencing the outcome of pulmonary infection in patients with cerebral hemorrhage using bedside ultrasound-guided indwelling nasoenteric tube technique

目的分析床旁超声引导留置鼻肠管技术下脑出血患者肺部感染转归的影响因素。方法回顾性分析2022年1月至2023年1月南阳市第二人民医院收治的200例经床旁超声引导留置鼻肠管技术下脑出血患者作为研究对象,其中89例肺部感染情况,根据肺部感染转归(入院28 d预后)分为不良组32例和良好组57例。比较两组患者的临床资料,采用Lasso和Logistic回归分析患者肺部感染转归的影响因素。结果两组患者的性别、体温、冠心病、糖尿病、高血脂、出血部位、白细胞计数(WBC)、血小板计数(PLT)、纤维蛋白原(Fib)比较差异均无统计学意义(P>0.05);而两组患者的神经功能缺损情况、肺部基础疾病、高血压、年龄、吸烟史、出血量、急性生理与慢性健康状况Ⅱ(APACHEⅡ)评分、格拉斯哥昏迷量表(GCS)评分、留置鼻肠管时间、气管切开、白蛋白(ALB)、血红蛋白(Hb)、降钙素原(PCT)、白介素-6(IL-6)、C反应蛋白(CRP)比较,差异均有统计学意义(P<0.05);将上述15个差异有统计学意义的变量纳入Lasso回归,筛选出的10个预测变量为年龄、高血压、APACHEⅡ评分、GCS评分、出血量、ALB、PCT、Hb、IL-6、CRP;经Logistic回归分析结果显示,高血压、年龄、APACHEⅡ评分、GCS评分、出血量、ALB、Hb、PCT、CRP是患者肺部感染预后不良的影响因素(P<0.05)。结论床旁超声引导留置鼻肠管技术下脑出血患者发生肺部感染反流误吸率较高,而年龄、高血压、APACHEⅡ评分、GCS评分、出血量、ALB、Hb、PCT、CRP是影响患者肺部感染转归因素。

Objective To analyze the factors influencing the outcome of pulmonary infection in patients with cerebral hemorrhage undergoing bedside ultrasound-guided indwelling nasoenteric tube technique.Methods A retrospective analysis was performed on 200 patients with cerebral hemorrhage treated in Nanyang Second People's Hospital from January 2022 to January 2023.Among them,89 patients had pulmonary infection,which were divided into the poor group(32 cases)and the good group(57 cases)according to the prognosis of pulmonary infection(28 days after admission).The clinical data were compared between the two groups of patients,and Lasso and logistic regression was used to analyze the influencing factors of lung infection outcome in patients.Results There was no significant difference between the two groups in gender,body temperature,coronary heart disease,diabetes,hyperlipidemia,bleeding site,white blood cell count(WBC),platelet count(PLT),and fibrinogen(Fib),P>0.05.However,there were statistically significant differences in neurological deficits,underlying lung diseases,hypertension,age,smoking history,bleeding volume,acute physiological and chronic health statusⅡ(APACHEⅡ)score,Glasgow Coma Scale(GCS)score,indwelling time of nasogastric tube,tracheotomy,albumin(ALB),hemoglobin(Hb),procalcitonin(PCT),interleukin-6(IL-6),and C-reactive protein(CRP)levels between the two groups(P<0.05).The 15 statistically significant variables mentioned above were incorporated into Lasso regression,and 10 predictive variables were screened out:age,hypertension,APACHEⅡscore,GCS score,bleeding volume,ALB,PCT,Hb,IL-6,and CRP.The results of logistic regression analysis showed that hypertension,age,APACHEⅡscore,GCS score,bleeding volume,ALB,Hb,PCT,CRP were the influencing factors for poor prognosis of pulmonary infection in patients(P<0.05).Conclusion The incidence of pulmonary infection reflux and aspiration in patients with cerebral hemorrhage under bedside ultrasound-guided indwelling nasoenteric tube technique is relatively high,while age,hypertension,APACHEⅡscore,GCS score,bleeding volume,ALB,Hb,PCT,CRP are factors that affect the prognosis of pulmonary infection in patients.