颅脑外伤术后患者肺部感染危险因素分析

Analysis on risk factors of pulmonary infection in postoperative patients with severe traumatic brain injury

目的研究重型颅脑外伤术后患者肺部感染相关危险因素,为临床诊治提供方向。方法选择62例重型颅脑外伤术后患者进行回顾性研究,根据肺部感染情况分为感染组(18例)、非感染组(44例),比较两组患者的年龄、性别、吸烟、饮酒、手术时间、术前血糖、气管开放时限、留置胃管、格拉斯哥昏迷评分(GCS评分)等特征,分析其与肺部感染的关系。结果感染组气道开放时限高于非感染组(20. 17±7. 97vs10. 36±4. 92,P <0. 05),GCS评分较非感染组明显降低(5. 22±1. 83vs7. 61±2. 52,P <0. 05);进一步分析显示气道开放时限及GCS评分与肺部感染发生呈正相关(OR=0. 741; OR=2. 365,P <0. 05);同时气道开放时限≥15 d者肺部感染发生率显著高于<15 d者(64. 7%vs26. 7%,P <0. 05),差异均有统计学意义。结论气道开放时限、GCS评分是重型颅脑外伤术后患者肺部感染的独立危险因素;肺部感染发生率随着气道开放时限的延长而升高。

Objective To study the risk factors of pulmonary infection in postoperative patients with severe traumatic brain injury,so as to provide guidance for clinical treatment. Methods Sixty-two postoperative patients with severe traumatic brain injury were analyzed retrospectively. According to whether pulmonary infections happened,they were divided into infection group( 18 cases) andnon-infection group( 44 cases),and analyzed the relationship between pulmonary infections and age,gender,smoking,drinking,operation time,level of preoperative blood glucose,tracheotomy time,nasogastric tube,score of GCS. Results The incidence of tracheotomy time is significantly higher than non-infection group( 20. 17 ± 7. 97 vs10. 36 ± 4. 92,P < 0. 05). Score of GCS in infectionis significantly lower than non-infection group( 5. 22 ± 1. 83 vs7. 61± 2. 52,P < 0. 05),and further analysis showed that tracheotomy time and score of GCS are positively correlated with pulmonary infections( OR = 0. 741;OR = 2. 365,P < 0. 05). The incidence of pulmonary infections in patients with the tracheotomy time≥15 days was significantly higher than that in tracheotomy time < 15 days( 64. 7% vs26. 7%,P < 0. 05). Conclusion Tracheotomy time and score of GCS are independent risk factors of pulmonary infections in postoperative patients with severe traumatic brain injury,and incidence of pulmonary infections gradually increases by tracheotomy time expand.