急性创伤性颅脑损伤患者术后肺部感染发生率及其危险因素分析

Postoperative pulmonary infection in patients with traumatic brain injury who experienced emergency neurosurgery

目的探究创伤性颅脑损伤(TBI)患者术后肺部感染的发生率及其危险因素。方法回顾性收集2016年1月1日至2018年12月31日于首都医科大学附属北京天坛医院行急诊脑创伤手术的TBI患者资料294例,根据术后是否发生肺部感染分为感染组(37例)和非感染组(257例)。记录患者肺部感染发生率。比较两组患者术前基线数据、术中数据、术后数据,将组间差异有统计学意义的变量纳入单因素logistic回归分析,再将单因素logistic回归分析中P<0.1的变量纳入多因素logistic回归分析,分析TBI患者术后肺部感染的危险因素及重型TBI患者术后肺部感染的独立危险因素。比较两组患者住院花费、住院时间、术后住院时间、是否入住重症监护治疗病房(ICU)、ICU停留时间、出院时格拉斯哥昏迷评分(GCS)、病死率。结果患者肺部感染发生率为12.6%。与非感染组比较:感染组饮酒史比例较高、脑疝比例较高,入院至手术时间较短(均P<0.05);术中麻醉时间、手术时间较长,术中收缩压波动(ΔSBP)较大,使用糖皮质激素、血管活性药物比例较高,出血量较多,输血比例较高,输血量较大,舒芬太尼用量较少,意识恢复比例较低,保留气管内导管(ETT)比例较高(均P<0.05);术后白蛋白较低,使用抗生素比例较高,保留ETT时间较长(均P<0.05)。单因素logistic回归分析显示,饮酒史[比值比(OR)2.713,95%置信区间(CI)1.298~5.670,P=0.008]、入院时低GCS(OR 0.769,95%CI 0.690~0.857,P<0.001)、麻醉时间长(OR 1.445,95%CI 1.155~1.807,P=0.001)、脑疝(OR 2.434,95%CI 1.209~4.901,P=0.013)、术中输血(OR 1.058,95%CI 1.025~1.093,P<0.001)、使用糖皮质激素(OR 2.517,95%CI 1.171~5.410,P=0.018)、意识恢复(OR 0.270,95%CI 0.080~0.910,P=0.035)、保留ETT(OR 12.483,95%CI 2.939~53.025,P=0.001)是TBI患者术后肺部感染的危险因素。多因素logistic回归分析结果显示,饮酒史(OR 2.689,CI 1.184~6.107,P=0.018)、入院时低GCS(OR 0.822,95%CI 0.728~0.929,P=0.002)、术中输血(OR 1.042,95%CI 1.006~1.079,P=0.023)是TBI患者术后肺部感染的独立危险因素。饮酒史(OR 5.038,95%CI 1.831~13.862,P=0.001)是重型TBI患者术后肺部感染的独立危险因素。与非感染组比较,感染组住院花费较高、住院时间较长、ICU停留时间较长、出院时GCS较低、病死率较高(均P<0.05)。结论TBI患者术后肺部感染发生率为12.6%,饮酒史、入院时低GCS、术中输血增加了TBI患者术后肺部感染的发生风险。

Objective To observe the incidence and risk factors of pulmonary infection after surgery in traumatic brain injury(TBI)patients.Methods Two hundred and ninety‑four TBI patients after emergency neurosurgical treatment at Beijing Tiantan Hos‑pital,Capital Medical University,between January 1st,2016,and December 31st,2018 were retrospectively collected.The patients were divided into an infection group(37 cases)and a non‑infection group(257 cases)according to whether pulmonary infection oc‑curred after surgery.The incidence of pulmonary infection was recorded.The preoperative,intraoperative,and postoperative data of the two groups were compared.The variables with statistically significant differences between the groups were included in the univariate lo‑gistic regression analysis.The variables with P<0.1 in the univariate logistic regression analysis were included in the multivariate logis‑tic regression analysis to analyze the independent risk factors of postoperative pulmonary infection in patients with TBI and factors of postoperative pulmonary infection in patients with severe TBI.The cost during hospitalization,hospitalization time,postoperative hospi‑talization time,admission rate to intensive care unit(ICU),ICU stay time,Glasgow Coma Score(GCS)at discharge,and mortality were compared between the two groups.Results The incidence of pulmonary infection was 12.6%.The proportion of drinking history and the proportion of cerebral hernia was high,and the time from admission to operation was short(all P<0.05)in the infection group com‑pared to the non‑infection group.Compared with the non‑infection group,the intraoperative anesthesia time and operation time of pa‑tients in the infection group were long,the fluctuation of intraoperative systolic blood pressure(ΔSBP)was large,the proportion of glu‑cocorticoids and vasoactive drugs,the amount of bleeding,the proportion of blood transfusion and the amount of blood transfusion was large,the amount of sufentanil and the proportion of consciousness recovery were low,and the proportion of retaining endotracheal tube(ETT)was high(all P<0.05).Compared with the non‑infection group,the postoperative albumin of patients in the infection group was low,and the proportion of antibiotics and the retention time of ETT was long(all P<0.05).Univariate logistic regression analysis showed that drinking history[odds ratio(OR)2.713(95%confidence interval(CI)1.298,5.670),P=0.008],low GCS at admission[OR 0.769(95%CI 0.690,0.857),P<0.001],long anesthesia time[OR 1.445(95%CI 1.155,1.807),P=0.001],brain herniation[OR 2.434(95%CI 1.209,4.910),P=0.013],intraoperative blood transfusion[OR 1.058(95%CI 1.025,1.093),P<0.001],use of glucocorticoids[OR 2.517,(95%CI 1.171,5.410),P=0.018],consciousness recovery[OR 0.270(95%CI 0.080,0.910),P=0.035],retaining ETT[OR 12.483(95%CI 2.939,53.025),P=0.001]were risk factors for postoperative pulmonary infection in TBI patients.Multivariate logistic regres‑sion analysis showed that drinking history[OR 2.689(95%CI 1.184,6.107),P=0.018],low GCS at admission[OR 0.822(95%CI 0.728,0.929),P=0.002],and intraoperative blood transfusion[OR 1.042(95%CI 1.006,1.079),P=0.023]were independent risk factors for postoperative pulmonary infection in TBI patients.Drinking history[OR 5.038(95%CI 1.831,13.862),P=0.001]was a independent risk factor for pulmonary infection in patients with severe TBI.Compared with the non‑infection group,the infection group had high hos‑pitalization costs,long hospitalization time,long ICU stay time,low GCS at discharge,and high mortality(all P<0.05).Conclusions The incidence of postoperative pulmonary infection in TBI patients was 12.6%.Drinking history,low GCS at admission,and intraopera‑tive blood transfusion increased the risk of postoperative pulmonary infection in TBI patients.