重度颅脑损伤患者早发性呼吸机相关性肺炎临床特征及相关因素的分析

doi:10.3969/j.issn.1002-1949.2018.10.010

摘要
图/表
参考文献(18)
相关文章 (15)

全文: PDF (629 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的评价重度外伤性脑损伤（sTBI）患者早发性呼吸机相关性肺炎（EOVAP）的发生率、危险因素和临床预后。方法采用回顾性分析，选取西宁市第三人民医院神经外科ICU治疗的206例sTBI患者的临床资料，根据是否发生EOVAP将患者分为EOVAP组与非EOVAP组，比较两组患者的临床资料，采用Logistic回归分析，评价患者发生EOVAP的危险因素，评价EOVAP对患者脑氧合及预后的影响。结果有125例（60.7%）sTBI患者诊断为EOVAP，影响患者发生EOVAP的危险因素为：亚低温治疗（OR=3.486，95%CI1.211～10.035，P=0.026）、胸部简明损伤定级（AIS）≥3（OR=2.429，95%CI 1.116～5.738，P=0.043）、入院气管导管内吸引培养阳性（OR=4.225，95%CI1.717～10.601，P=0.003）及胃内容物吸入（OR=5.258，95%CI1.723～15.998，P=0.004）。预防性使用抗菌药物是EOVAP的保护因素（OR=0.313，95%CI0.157～0.891，P=0.011）。与非EOVAP组比较，EOVAP组患者脑组织氧分压与氧合指数显著降低（t=3.489、17.584，P均<0.001）。多因素Logistic回归分析表明，EOVAP与预后不良显著相关（OR=2.719，95%CI1.017～7.252，P=0.038）。结论 sTBI患者EOVAP发病率较高，其中主要危险因素为亚低温治疗、严重胸部病变和胃内容物吸入。EOVAP对患者脑氧合有不良影响，并与患者1年预后不良独立相关。因此，临床医师应采取一切必要的措施预防sTBI患者发生EOVAP。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	张西强
	何多奇
	云慧斌
	孙玉
	王春梅

关键词 ：外伤性脑损伤（TBI）, 呼吸机相关性肺炎（VAP）, 相关因素, 预后

作者简介: 张西强(1973-)，男，主治医师，E-mail:zhangxiqiangnx@sohu.com。

引用本文:

张西强，何多奇，云慧斌，孙玉，王春梅. 重度颅脑损伤患者早发性呼吸机相关性肺炎临床特征及相关因素的分析[J]. 中国急救医学, 2018, 38(10): 879-884.
Zhang Xi-qiang, He Duo-qi, Yun Hui-bin, Sun Yu, Wang Chun-mei. Clinical characteristics and related factors of early-onset ventilator-associated pneumonia in patients with severe traumatic brain injury. Chinese Journal of Critical Care Medicine, 2018, 38(10): 879-884.

链接本文:

http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2018.10.010 或 http://www.cnemergency.org.cn/CN/Y2018/V38/I10/879

［1］Saensom D, Merchant AT, Wara-Aswapati N, et al. Oral health and ventilator-associated pneumonia among critically ill patients: a prospective study［J］. Oral Dis, 2016, 22(7): 709-714. ［2］梁英健,李志亮, 王亮, 等. 早发和晚发呼吸机相关性肺炎危险因素及病原菌分析［J］. 中华内科杂志, 2017, 56(10): 743-746. ［3］薛海, 孟祥雨, 董金千, 等.重型颅脑损伤并发医院获得性肺炎的相关因素分析［J］. 中华神经外科杂志, 2018, 34(2): 124-128. ［4］Chieregato A, Malacarne P, Cocciolo F, et al. Aggressive versus conservative antibiotic use to prevent and treat ventilator-associated〖JP〗 pneumonia in patients with severe traumatic brain injury: comparison of two case series［J］. Minerva Anestesiol, 2017, 83(6): 553-562. ［5］Oddo M, Levine JM, Mackenzie L, et al. Brain hypoxia is associated with short-term outcome after severe traumatic brain injury independently of intracranial hypertension and low cerebral perfusion pressure［J］. Neurosurgery, 2011, 69(5): 1037-1045. ［6］高亮. 美国第四版《重型颅脑损伤救治指南》解读［J］. 中华神经创伤外科电子杂志, 2017, 3(6): 321-324. ［7］曹江红, 李光辉. 美国感染病学会和美国胸科学会2016年成人医院获得性肺炎和呼吸机相关性肺炎的处理临床实践指南［J］. 中国感染与化疗杂志, 2017, 17(2): 209-214. ［8］Jovanovic B, Milan Z, Markovic-Denic L, et al. Risk factors for ventilator-associated pneumonia in patients with severe traumatic brain injury in a Serbian trauma centre［J］. Int J Infect Dis, 2015, 38: 46-51. ［9］Restrepo MI, Peterson J, Fernandez JF, et al. Comparison of the bacterial etiology of early-onset and late-onset ventilator-associated pneumonia in subjects enrolled in 2 large clinical studies［J］. Respir Care, 2013, 58(7): 1220-1225. ［10］Bronchard R, Albaladejo P, Brezac G, et al. Early onset pneumonia: risk factors and consequences in head trauma patients［J］. Anesthesiology, 2004, 100(2): 234-239. ［11］Perbet S, Mongardon N, Dumas F, et al. Early-onset pneumonia after cardiac arrest: characteristics, risk factors and influence on prognosis［J］. Am J Respir Crit Care Med, 2011, 184(9): 1048-1054. ［12］O′Phelan KH, Merenda A, Denny KG, et al. Therapeutic temperature modulation is associated with pulmonary complications in patients with severe traumatic brain injury［J］. World J Crit Care Med, 2015, 4(4): 296-301. ［13］张小文, 王文冰. 长期亚低温与短期亚低温治疗重型颅脑损伤效果对比［J］. 中国急救医学, 2017, 37(z2): 171-172.  ［14］Crossley S, Reid J, McLatchie R, et al. A systematic review of therapeutic hypothermia for adult patients following traumatic brain injury［J］. Crit Care, 2014, 18(2): R75. ［15］Kesinger MR, Kumar RG, Wagner AK, et al. Hospital-acquired pneumonia is an independent predictor of poor global outcome in severe traumatic brain injury up to 5 years after discharge［J］. J Trauma Acute Care Surg, 2015, 78(2): 396-402. ［16］Godoy DA, Lubillo S, Rabinstein AA. Pathophysiology and Management of Intracranial Hypertension and Tissular Brain Hypoxia After Severe Traumatic Brain Injury: An Integrative Approach［J］. Neurosurg Clin N Am, 2018, 29(2): 195-212. ［17］Bao L, Chen D, Ding L, et al. Fever burden is an independent predictor for prognosis of traumatic brain injury［J］. PLoS One, 2014, 9(3): e90 956. ［18］胡宝吉, 薄禄龙, 邓小明. 脑外伤患者围手术期液体及代谢管理［J］. 国际麻醉学与复苏杂志, 2013, 34(6): 541-543.