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目的探讨颅脑手术后患者发生下呼吸道感染及预后的相关因素。方法收集2014年12月~2015年7月我院242例颅脑术后患者的临床资料,应用多因素分析发生下呼吸道感染及预后的相关因素。结果 242例颅脑术后患者发生下呼吸道感染64例,感染率为26.45%,合并下呼吸道感染患者经治疗后死于多器官功能衰竭34例。64例下呼吸道感染患者中共分离出病原菌87株,以革兰阴性菌为主,占77.01%,其次是革兰阳性菌,占13.79%,真菌占9.20%;年龄、高血压、糖尿病、手术类型、住院时间、侵入性操作(吸痰、气管插管、气管切开)、GCS评分、手术时间、糖皮质激素使用、抗生素种类、术后低白蛋白、抑酸剂使用、脱水剂使用、吸烟与患者发生下呼吸道感染有关(P<0.05),其中死亡组与对照组GCS评分、术后低白蛋白比较,差异有统计学意义(P<0.05)。多因素分析显示,GCS评分、侵入性操作(吸痰、气管插管、气管切开)、抗生素种类是颅脑术后患者发生下呼吸道感染的独立危险因素(P<0.05),GCS评分、术后低白蛋白是颅脑术后患者并发下呼吸道感染死亡的独立危险因素(P<0.05)。结论颅脑术后患者下呼吸道感染的发生与GCS评分低、抗生素的不合理使用及侵入性操作有密切相关性,GCS评分低和术后低白蛋白的患者预后差,应在临床工作中针对以上危险因素进行必要干预,以降低下呼吸道感染的发生率,改善患者预后。
Objective To investigate the related factors of lower respiratory tract infection and prognosis in patients after craniocerebral surgery. Methods Clinical data of 242 patients with craniocerebral surgery in our hospital from December 2014 to July 2015 were collected. Multivariate analysis was used to analyze the related factors of lower respiratory tract infection and prognosis. Results 242 cases of lower respiratory tract infection in patients after craniocerebral surgery occurred in 64 cases, the infection rate was 26.45%. Patients with lower respiratory tract infection died of multiple organ failure after treatment. Among the 64 patients with lower respiratory tract infection, 87 strains of pathogens were isolated, mainly Gram-negative bacteria, accounting for 77.01%, followed by Gram-positive bacteria, accounting for 13.79%, fungi accounting for 9.20%; age, hypertension, diabetes, type of surgery , Duration of hospitalization, invasive procedures (suction, endotracheal intubation, tracheotomy), GCS score, duration of operation, glucocorticoid use, antibiotic type, postoperative low albumin, antacid use, dehydrating agent use, smoking (P <0.05). There was significant difference between GCS score of death group and control group and postoperative low albumin (P <0.05). Multivariate analysis showed that GCS score, invasive procedure (suctioning, tracheal intubation, tracheotomy) and antibiotic types were independent risk factors of lower respiratory tract infection (P <0.05), GCS score Post-low albumin is an independent risk factor for the death of lower respiratory tract infection after craniocerebral surgery (P <0.05). Conclusion The incidence of lower respiratory tract infection in patients with craniocerebral surgery is associated with low GCS score, unreasonable use of antibiotics and invasive procedure. The patients with low GCS score and low albumin after operation have poor prognosis and should be treated in clinical practice The above risk factors for the necessary intervention to reduce the incidence of lower respiratory tract infection and improve patient prognosis.