摘要
目的探讨急性硬膜下血肿手术患者术后肺部感染危险因素。方法回顾性分析2014年1月-2016年12月共120例急性硬膜下血肿手术患者,采用Logistic回归法从性别、年龄、病程方面进行术后肺部感染危险因素分析。结果 120例患者中术后肺部感染29例,发生率24. 17%,肺部感染出现时间为术后1-18(6. 2±1. 3) d,所有患者均在5-32(10. 6±4. 7) d痊愈;危险因素单因素有呼吸机辅助通气、GCS评分低(≤7分)、应用药物不规范、伴有意识障碍、术前凝血功能异常、病房环境污染、血肿量大、中线偏移大、误吸、昏迷时间长、既往有吸烟或肺炎史、气道不通畅有关(P均<0. 05);而和性别、年龄、血肿厚度、术中脑肿胀无关(P> 0. 05);经非条件Logistic回归分析,呼吸机辅助通气、应用药物、意识障碍、术前凝血功能、病房环境、误吸、昏迷时间、既往史、气道不通畅有关是术后肺部感染危险因素独立影响因素(P分别=0. 023、0. 019、0. 014、0. 008、0. 031、0. 031、0. 021、0. 017、0. 027),而和血肿量、中线偏移、GCS评分无关(p分别=0. 094、0. 086、0. 055)。结论加强呼吸道管理,减少侵袭性操作,合理使用药物,做好病房消毒隔离工作,完善相关检查并及时处理是降低急性硬膜下血肿术后肺部感染有效措施。
Objective To investigate the risk factors of postoperative pulmonary infection in patients with acute subdural hematoma. Methods The clinical data of 120 cases received acute subdural hematoma were retrospectively analyzed, and it used Logistic regression to analyze the risk factors through sex, age, and disease course. Results There were 29 cases of postoperative pulmonary infection, and the incidence was 24.17%. The appearing time of pulmonary infection was 1-18 （6.2±1.3） d, and all patients were cured in 5-32 （10.6±4.7） d. The single risk factors for ventilator assisted ventilation included GCS score ≤7, non-standard application of drugs, disorder of consciousness, preoperative coagulation abnormalities, ward environment pollution, large hematoma volume, midline shift, aspiration, long coma time, history of smoking or history of pneumonia and airway patency （ P〈 0.05）, and it had no correlation with gender, age, hematoma thickness, or intraoperative brain swelling （ P〉 0.05）. The non-conditional Logistic regression analysis showed mechanical ventilation, drug use, disorder of consciousness, preoperative coagulation function, ward environment pollution, aspiration, long coma time, and airway patency are independent risk factors for postoperative pulmonary infection, （ P =0.023, 0.019, 0.014, 0.008, 0.031, 0.031, 0.021, 0.017, 0.027）, excluding haematoma, midline deviation and GCS score （ P =0.094, 0.086, 0.055）. Conclusion The effective measures to control pulmonary infection in patients with acute subdural hematoma is to strengthen the management of respiratory tract, reduce invasive operation, rational use of drugs to ward disinfection and isolation work.
作者
孙夕峰
樊永忠
王猛
SUN Xi-feng;FAN Yong-zhong;WANG Meng(Department of Neurosurgery,Danyang Hospital Affiliated to Nantong University,Danyang,Jiangsu 212300,China)
出处
《临床肺科杂志》
2018年第12期2179-2183,共5页
Journal of Clinical Pulmonary Medicine
关键词
急性硬膜下血肿
肺部感染
危险因素
预防对策
acute subdural hematoma
pulmonary infection
risk factors
preventive measures
