-
摘要: 目的:探索创伤患者肺部感染的危险因素及其对预后的影响,指导临床救治,改善疗效。方法:回顾性分析2016年1月—2018年1月期间660例创伤患者的临床资料,其中男497例,女163例。采用Logistic回归分析创伤患者肺部感染对预后(28 d死亡事件)的影响及相关危险因素。结果:660例患者中,共有124例发生肺部感染(18.8%),536例未发生肺部感染(81.2%)。28 d死亡病例为46例(6.96%),其中肺部感染患者35例(28.23%)显著高于非肺部感染组11例(2.05%)(P<0.01),肺部感染是创伤患者死亡的重要独立危险因素(OR=12.83,95%CI:5.70~28.89,P<0.01)。多因素Logistic回归分析提示年龄(OR=1.02,95%CI:1.01~1.03,P=0.001)、严重损伤[损伤严重程度评分(ISS)≥16](OR=6.86,95%CI:3.87~12.16,P<0.01)、胸部损伤(OR=2.54,95%CI:1.20~5.37,P=0.015)、急诊手术(OR=2.21,95%CI:1.35~3.61,P=0.002)和收入ICU(OR=2.43,95%CI:1.21~4.86,P=0.013)是创伤患者发生肺部感染的独立危险因素。结论:创伤患者发生肺部感染与年龄、ISS≥16、发生胸部损伤、接受急诊手术和入住ICU等因素密切相关,有效预防和治疗肺部感染是改善创伤患者预后的重要环节。Abstract: Objective: To explore the risk factors of pulmonary infection in trauma patients and their influence on prognosis, to guide clinical treatment and improve the curative effect.Methods: The clinical data of 660 trauma patients from January 2016 to January 2018 were retrospectively analyzed, including 497 males and 163 females. Logistic regression was used to analyze the influence of lung infection in trauma patients on the prognosis(28-day death event) and related risk factors.Results: A total of 124 cases(18.8%) developed pulmonary infection, while 536 cases(81.2%) did not. There were 46 deaths(6.96%) at 28 days, of which 35(28.23%) patients with lung infection were significantly higher than 11(2.05%) in the non-pulmonary infection group(P<0.01). Pulmonary infection was an important independent risk factor of death in trauma patients(OR=12.83, 95%CI:5.70-28.89, P<0.01). Multivariate Logistic regression analysis indicated that age(OR=1.02, 95%CI:1.01-1.03, P=0.001), severe injury(injury severity score, ISS≥16)(OR=6.86, 95%CI:3.87-12.16, P<0.01), chest injury(OR=2.54, 95%CI:1.20-5.37, P=0.015), emergency surgery(OR=2.21, 95%CI:1.35-3.61, P=0.002) and ICU admission(OR=2.43, 95%CI:1.21-4.86, P=0.013) were the independent risk factors for pulmonary infection in trauma patients.Conclusion: Pulmonary infection in trauma patients is closely related to age, ISS≥16, occurrence of chest injury, emergency surgery, ICU admission and other factors. Effective prevention and treatment of pulmonary infection is an important link to improve the prognosis of patients with trauma.
-
Key words:
- trauma /
- pulmonary infection /
- prognosis /
- risk factors
-
[1] Chen N,Zhang C,Hu S.Strengthening trauma care in China[J].BMJ,2017,359:j5545.
[2] 林超,何洪泉,侯立军,等.颅脑创伤患者肺部感染的危险因素分析[J].中华创伤杂志,2015,31(9):820-822.
[3] Hofman M,Andruszkow H,Kobbe P,et al.Incidence of post-traumatic pneumonia in poly-traumatized patients:identifying the role of traumatic brain injury and chest trauma[J].Eur J Trauma Emerg Surg,2020,46(1):11-19.
[4] 中华医学会呼吸病学分会感染学组.中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南(2018年版)[J].中华结核和呼吸杂志,2018,41(4):255-280.
[5] Kleber C,Giesecke MT,Tsokos M et al.Trauma-related preventable deaths in Berlin 2010:need to change prehospital management strategies and trauma management education[J].World J Surg,2013,37(5):1154-1161.
[6] Mangram AJ,Sohn J,Zhou N et al.Trauma-associated pneumonia:time to redefine ventilator-associated pneumonia in trauma patients[J].Am J Surg,2015,210(6):1056-1062.
[7] Hu PJ,Pittet JF,Kerby JD,et al.Acute brain trauma,lung injury,and pneumonia:more than just altered mental status and decreased airway protection[J].Am J Physiol Lung Cell Mol Physiol,2017,313(1):L1-L15.
[8] Eguia E,Cobb AN,Baker MS et al.Risk factors for infection and evaluation of Sepsis-3 in patients with trauma[J].Am J Surg,2019,218(5):851-857.
[9] 张旗,李海山,左爽.多发伤患者死亡的危险因素分析[J].临床急诊杂志,2019,20(7):517-520.
[10] Valparaiso Apple P,Vicente Diego A,Bograd Benjamin A et al.Modeling acute traumatic injury[J].J Surg Res,2015,194(1):220-232.
[11] Machado-Aranda D,V Suresh M,Yu B,et al.Alveolar macrophage depletion increases the severity of acute inflammation following nonlethal unilateral lung contusion in mice[J].J Trauma Acute Care Surg,2014,76(4):982-90.
[12] Dhar SM,Breite MD,Barnes SL et al.Pulmonary Contusion in Mechanically Ventilated Subjects After Severe Trauma[J].Respir Care,2018,63(8):950-954.
[13] Prevaldi C,Paolillo C,Locatelli C,et al.Management of traumatic wounds in the Emergency Department:position paper from the Academy of Emergency Medicine and Care(AcEMC)and the World Society of Emergency Surgery(WSES)[J].World J Emerg Surg,2016,11:30.
[14] Kazaure HS,Martin M,Yoon JK,et al.Long-term results of a postoperative pneumonia prevention program for the inpatient surgical ward[J].JAMA Surg,2014,149(9):914-918.
[15] Sribnick EA,Hensley J,Moore-Clingenpeel M,et al.Nosocomial Infection Following Severe Traumatic Injury in Children.[J]Pediatr Crit Care Med,2020,21(5):443-450.
[16] Buetti N,Timsit JF.Management and Prevention of Central Venous Catheter-Related Infections in the ICU[J].Semin Respir Crit Care Med,2019,40(4):508-523.
[17] 谢朝云,闫飞,熊永发,等.骨科创伤患者医院获得性肺炎的危险因素[J].中国感染控制杂志,2017,16(3):207-210,214.
[19] Sharpe JP,Magnotti LJ,Weinberg JA,et al.Gender disparity in ventilator-associated pneumonia following trauma:identifying risk factors for mortality[J].J Trauma Acute Care Surg,2014,77(1):161-165.
[19] Yadollahi M,Kashkooe A,Feyzi M et al.Risk factors of mortality in nosocomial infected traumatic patients in a trauma referral center in south of Iran[J].Chin J Traumatol,2018,21(5):267-272.
计量
- 文章访问数: 198
- PDF下载数: 222
- 施引文献: 0