高血压脑出血术后患者继发肺部感染的病原学特点及风险因素分析

Microbiological characteristics and risk factors of secondary pulmonary infection after surgery for hypertensive cerebral hemorrhage

目的探讨高血压脑出血术后继发肺部感染的病原学特点并分析其风险因素。方法回顾性分析。抽取2020年2月至2022年6月安阳市人民医院收治的高血压脑出血患者92例,所有患者在入院后均行颅内血肿清除术,并依据术后是否发生肺部感染分为肺部感染组(39例)与非肺部感染组(53例)。术后采集感染组患者的呼吸道分泌物进行病原菌的分离与鉴定;收集感染组与非感染组患者的一般资料、吸烟史、糖尿病病史、发病后是否呕吐、术前格拉斯哥昏迷评分法(GCS)评分、气管插管时间与术后是否气管切开等临床资料,并进行单因素与多因素Logistic回归分析。结果病原菌分析结果显示,39例感染组患者呼吸道分泌物中共分离出病原菌59株,其中革兰阳性菌32株(54.24%),革兰阴性菌27株(45.76%)。单因素分析结果显示,吸烟史(P=0.015)、糖尿病病史(P=0.002)、发病后呕吐史(P<0.001)、术前GCS评分(P=0.017)、气管插管时间(P=0.009)以及术后是否气管切开(P<0.001)为高血压脑出血患者术后感染的影响因素。多因素Logistic回归分析结果显示,吸烟史(P=0.019)、糖尿病病史(P=0.027)、发病后呕吐(P=0.012)、术前GCS评分低(P=0.023)、气管插管时间延长(P=0.006)以及术后气管切开(P=0.028)是高血压脑出血术后并发肺部感染的独立危险因素。结论高血压脑出血术后并发肺部感染的患者中发生革兰阳性菌感染的患者比例更高;吸烟史、糖尿病病史、发病后呕吐、术前GCS评分低、气管插管时间延长以及术后气管切开是高血压脑出血患者术后并发肺部感染的独立危险因素。

Objective To investigate the microbiological characteristics and risk factors of postoperative secondary pulmonary infection after surgery for hypertensive cerebral hemorrhage.Methods A total of 92 patients with hypertensive cerebral hemorrhage admitted to Anyang People’s Hospital from February 2020 to June 2022 were selected for the retrospective analysis study.All the patients underwent intracranial hematoma removal surgery after admission,and were divided into the pulmonary infection group(39 cases)and the non-pulmonary infection group(53 cases)according to the occurrence of pulmonary infection after surgery.Respiratory secretions of patients in the infection group were collected for pathogen isolation and identification.The general data,smoking history,history of diabetes,vomiting after onset,preoperative Glasgow coma scale(GCS)score,time of tracheal intubation,tracheotomy after operation of the pulmonary infection group and the non-pulmonary infection group were collected.Univariate and multivariate logistic regression analysis were performed.Results Results of microbiological characteristics analysis showed that a total of 59 strains of pathogens were isolated from the respiratory secretions from the 39 infected patients,including 32 strains(54.24%)of Gram positive bacteria and 27 strains(45.76%)of Gram negative bacteria.The results of univariate analysis showed that the history of smoking(P=0.015),history of diabetes(P=0.002),vomiting history after onset(P<0.001),preoperative GCS score(P=0.017),time of tracheal intubation(P=0.009)and performance of postoperative tracheotomy(P<0.001)were the influencing factors of postoperative infection in patients with hypertensive cerebral hemorrhage.Results of multivariate logistic regression analysis showed that the history of smoking(P=0.019),history of diabetes(P=0.027),vomiting after onset(P=0.012),low preoperative GCS score(P=0.023),prolonged tracheal intubation time(P=0.006)and postoperative tracheotomy(P=0.028)were independent risk factors for pulmonary infection after hypertensive cerebral hemorrhage surgery.Conclusions The proportion of patient infected by Gram-positive bacteria is higher among patients with secondary pulmonary infection after hypertensive cerebral hemorrhage surgery.History of smoking,history of diabetes,vomiting after onset,low preoperative GCS score,prolonged tracheal intubation time and postoperative tracheotomy are independent risk factors for postoperative pulmonary infection in patients after surgery for hypertensive cerebral hemorrhage.