Royon V, Guitard P-G, Abriou C, Frebourg N, Menard J-F, Clavier T, Dureuil B, Veber B
Pôle réanimations-anesthésie-Samu, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France.
Ann Fr Anesth Reanim. 2012 Nov;31(11):870-5. doi: 10.1016/j.annfar.2012.08.014. Epub 2012 Oct 6.
Pulmonary contusion (PC) is common in cases of polytrauma. The aim of this study was to perform a multivariate analysis of risk factors associated with the occurrence of infection in PC and analyze the microbiological epidemiology.
All patients with PC admitted to the intensive care unit (ICU) between January 2002 and December 2006 were included in this retrospective observational study. Patients with penetrating thoracic trauma or those who died in the 48hours following admission to hospital were excluded. Diagnosis of bacterial infection in PC was performed if hyperthermia was associated with a positive quantitative culture (103 colony forming units/mL) on the bronchial sample. Univariate analysis provided statistical difference between variables that were integrated in the multivariate analysis model. Multivariate analysis was then performed to determine the risk factors of bacterial infection in PC.
One hundred and seventeen patients were included. The incidence of bacterial infection in PC was 33.3% (39 patients). The most frequently encountered bacteria were Haemophilus sp., Staphylococcus aureus, Enterobacteriaceae, Pseudomonas sp. and Streptococcus sp. According to multivariate analysis, the existence of hypothermia at hospital admission increased the risk of PC infection (OR=2.61; IC 95% [4.2-13.3]).
In conclusion, PC was infected in 33.3% of cases. The existence of hypothermia was identified as a risk factor. A prospective study is warranted to confirm these results.
肺挫伤（PC）在多发伤病例中很常见。本研究的目的是对与PC感染发生相关的危险因素进行多因素分析，并分析微生物流行病学。
本回顾性观察研究纳入了2002年1月至2006年12月期间入住重症监护病房（ICU）的所有PC患者。排除穿透性胸部创伤患者或入院后48小时内死亡的患者。如果高热与支气管样本定量培养阳性（103菌落形成单位/mL）相关，则诊断为PC细菌感染。单因素分析提供了纳入多因素分析模型的变量之间的统计学差异。然后进行多因素分析以确定PC细菌感染的危险因素。
纳入117例患者。PC细菌感染发生率为33.3%（39例患者）。最常遇到的细菌是嗜血杆菌属、金黄色葡萄球菌、肠杆菌科、假单胞菌属和链球菌属。根据多因素分析，入院时体温过低会增加PC感染风险（OR=2.61；95%可信区间[4.2-13.3]）。
总之，33.3%的病例发生了PC感染。体温过低被确定为一个危险因素。有必要进行前瞻性研究以证实这些结果。
