Department of Neurosurgery, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, Jiangsu, China.
BMC Pulm Med. 2022 Apr 7;22(1):130. doi: 10.1186/s12890-022-01928-w.
Pulmonary infection is common yet serious complication in patients with severe traumatic brain injury (STBI). We aimed to evaluate the predicators of pulmonary infection in STBI patients undergoing tracheostomy, to provide evidence for the clinical nursing care of STBI patients.
This study was a retrospective cohort design. STBI patients undergoing tracheostomy treatment from January 1, 2019 to August 31, 2021 in our hospital were included. The characteristics of pulmonary infection and no pulmonary infection patients were analyzed.
A total 216 STBI patients undergoing tracheostomy were included, the incidence of pulmonary infection was 26.85%. Diabetes (r = 0.782), hypoproteinemia (r = 0.804), duration of coma(r = 0.672), duration of mechanical ventilation(r = 0.724) and length of hospital stay (r = 0.655), length of hospital stay post tracheostomy (r = 0.554), mortality (r = 0.598) were all correlated with pulmonary infection (all p < 0.05). Klebsiella pneumoniae (33.87%) and Staphylococcus aureus (29.03%) were the most commonly seen pathogens in the pulmonary infection of TBI patients. Logistic regression analyses indicated that diabetes (OR 2.232, 95% CI 1.215-3.904), hypoproteinemia with plasma total protein < 60 g/L (OR 1.922, 95% CI 1.083-3.031), duration of coma ≥ 22 h (OR 2.864, 95% CI 1.344-5.012), duration of mechanical ventilation ≥ 5 days (OR 3.602, 95% CI 1.297-5.626), length of hospital stay ≥ 21 days (OR 2.048, 95% CI 1.022-3.859) were the risk factors of pulmonary infection in TBI patients undergoing tracheostomy (all p < 0.05).
Further investigations on the early preventions and treatments targeted on those risk factors are needed to reduce the pulmonary infection in clinical practice.
肺部感染是严重创伤性脑损伤（STBI）患者常见且严重的并发症。我们旨在评估行气管切开术的 STBI 患者肺部感染的预测因素，为 STBI 患者的临床护理提供依据。
本研究为回顾性队列设计。纳入我院 2019 年 1 月 1 日至 2021 年 8 月 31 日行气管切开术的 STBI 患者。分析肺部感染和非肺部感染患者的特征。
共纳入 216 例行气管切开术的 STBI 患者，肺部感染发生率为 26.85%。糖尿病（r=0.782）、低蛋白血症（r=0.804）、昏迷时间（r=0.672）、机械通气时间（r=0.724）、住院时间（r=0.655）、气管切开术后住院时间（r=0.554）、死亡率（r=0.598）与肺部感染均相关（均 P<0.05）。肺炎克雷伯菌（33.87%）和金黄色葡萄球菌（29.03%）是 TBI 患者肺部感染最常见的病原体。Logistic 回归分析表明，糖尿病（OR 2.232，95%CI 1.215-3.904）、血浆总蛋白<60 g/L（OR 1.922，95%CI 1.083-3.031）、昏迷时间≥22 h（OR 2.864，95%CI 1.344-5.012）、机械通气时间≥5 d（OR 3.602，95%CI 1.297-5.626）、住院时间≥21 d（OR 2.048，95%CI 1.022-3.859）是 TBI 患者行气管切开术后肺部感染的危险因素（均 P<0.05）。
需要进一步研究针对这些危险因素的早期预防和治疗措施，以减少临床实践中的肺部感染。
