开颅手术后肺炎的危险因素分析

发布时间：2018-07-09 10:02

  本文选题：开颅手术 + 肺炎　； 参考：《广西医科大学》2017年硕士论文

【摘要】：目的:通过对神经外科行开颅手术住院患者的病例资料进行回顾性分析,探讨开颅术后肺炎的危险因素,为降低术后肺炎的发生率制定预防策略提供参考依据。材料与方法:收集2014.1-2015.12广西医科大学第一附属医院神经外科住院行开颅手术的880例患者进行回顾性研究,记录患者的一般情况和感染相关因素包括:性别、年龄、身高、体重、吸烟史、胸部X线或CT、术前合并基础疾病、手术类型、失血量、输血、手术持续时间、麻醉ASA分级、手术分级、术前住院时间、气管切开、术后留置胃管、机械通气时间、有无肺炎等。计量资料采用独立样本T检验,计数资料采用卡方检验对这些变量进行单因素分析,若1T5,取校正X2值,筛选出具有统计学意义的变量,进行二分类反应变量的非条件多因素logistic回归分析得出术后肺炎的独立危险因素。结果:开颅术后发生肺炎的患者共178例,发生率为20.23%。经单因素分析发现与以下11个因素相关:年龄、输血、失血量、急诊手术、气管切开、.术后留置胃管、机械通气时间≥4h、术前合并基础疾病、ASA分级、手术持续时间及术前住院时间。二分类反应变量的非条件多因素logistic回归分析结果显示有7个变量为术后肺炎独立危险因素,按OR值从大到小排序分别为:气管切开(OR=27.727,95%CI:2.493-308.348)、术后留置胃管(OR=4.550,95%CI:2.537-8.161)、急诊手术(OR=4.339,95%CI:1.490-12.631)、机械通气时间≥4h(OR=2.806,95%CI:1.369-5.75)、术前住院时间(OR=1.055,95%CI:1.016-1.095)、年龄(OR=1.027,95%CI:1.013-1.042)、手术持续时间(OR=1.004,95%CI:1.002-1.005)。结论:开颅术后肺炎发生率高,为多因素协同作用所致,主要因素包括年龄、输血、失血量、急诊手术、气管切开、机械通气时间、术后留置胃管、术前合并基础疾病、ASA分级、手术持续时间及术前住院时间。而气管切开、术后留置胃管、急诊手术、机械通气时间、手术持续时间、年龄及手术前住院时间是术后肺炎独立的危险因素。因此,有效的预防及控制策略尤为重要。
[Abstract]:Objective: to study the risk factors of pneumonia after craniotomy by retrospective analysis of the data of inpatients undergoing craniotomy in order to provide reference for reducing the incidence of postoperative pneumonia. Materials and methods: a retrospective study was conducted on 880 patients undergoing craniotomy in the Neurosurgery Department of the first affiliated Hospital of Guangxi Medical University from January to May 2014.The general situation of the patients and the related infection factors including sex, age, height, weight were recorded. History of smoking, chest X-ray or CT, preoperative underlying diseases, types of surgery, blood loss, blood transfusion, duration of surgery, anaesthesia ASA grading, surgical grading, preoperative hospitalization, tracheotomy, postoperative gastric tube indwelling, mechanical ventilation time, Pneumonia, etc. The measurement data were tested by independent sample T test, and the counting data were analyzed by chi-square test. If 1T5, the corrected value of X2 was taken to screen out the variables with statistical significance. Non-conditional multivariate logistic regression analysis of two-class response variables was performed to determine the independent risk factors for postoperative pneumonia. Results: there were 178 cases of pneumonia after craniotomy, the incidence was 20.23. Univariate analysis showed that the following 11 factors were correlated: age, blood transfusion, blood loss, emergency surgery, tracheotomy. After operation, the gastric tube was placed, the mechanical ventilation time was more than 4 hours, the preoperative ASA grade, the operative duration and the preoperative hospitalization time were associated with the underlying diseases. Non-conditional multivariate logistic regression analysis showed that 7 variables were independent risk factors for postoperative pneumonia. 鎸塐R鍊间粠澶у埌灏忔帓搴忓垎鍒�涓�:姘旂�″垏寮�(OR=27.727,95%CI:2.493-308.348),鏈�鍚庣暀缃�鑳冪��(OR=4.550,95%CI:2.537-8.161),鎬ヨ瘖鎵嬫湳(OR=4.339,95%CI:1.490-12.631),鏈烘�伴�氭皵鏃堕棿鈮，

本文编号：2108998