颈髓损伤患者发生医院获得性肺炎的影响因素研究

摘要

Objective To investigate the incidence of hospital acquired pneumonia ( HAP) in patients with cervical spinal cord injury (CSCI) and explore its influencing factors , in order to provide references for the prevention of HAP .Methods In this prospective study , we enrolled 358 patients with CSCI who were admitted into the First People′s Hospital of Tongxiang from March, 2010 to March, 2014.According to whether HAP occurred , the subjects were divided into two groups: HAP group and non-HAP group.Univariate analysis and Logistic regression analysis were conducted to investigate influencing factors for HAP in patients with CSCI .Results HAP mostly occurred 72.0 to 96.0 hours after CSCI occurred , with an average time range of (86.5 ±11.9) hours.The incidence rate of HAP was 30.2% (108 cases).The HAP group (n=108) and non-HAP group (n =250) were significantly different (P <0.05) in age, injury segment, JOA score, hypoproteinemia, hypoxemia , methylprednisolone treatment within 8.0 hours after injury , mechanical ventilation , tracheotomy and hospitalization time .Logistic regression analysis showed that the tracheotomy (OR=4.345, P<0.001), JOA score (OR=3.213, P=0.004), mechanical ventilation (OR=2.375, P=0.012), injury segment (OR=1.847, P=0.023) and hospitalization time (OR=1.235, P=0.031) were independent influencing factors for HAP in CSCI patients .Conclusion The incidence of HAP is high in CSCI patients, and tracheotomy, JOA score, mechanical ventilation, injury segment and hospitalization time are influencing factors for HAP in CSCI patients .%目的：分析颈髓损伤患者医院获得性肺炎（ HAP）的发病情况，探讨其影响因素，为预防HAP提供参考。方法本研究采用前瞻性研究方法，选择2010年3月—2014年3月在桐乡市第一人民医院住院治疗的358例颈髓损伤患者为研究对象。依据是否发生HAP分为HAP组和非HAP组，采用单因素分析和Logistic回归分析探讨颈髓损伤患者发生HAP的影响因素。结果 HAP多发生在颈髓损伤后72.0～96.0 h，平均（86.5±11.9） h；颈髓损伤患者HAP的发生率为30.2％（108例）。 HAP组（n ＝108）和非HAP组（n＝250）的年龄、损伤节段、日本骨科协会（JOA）评分、低蛋白血症、低氧血症、伤后8.0 h内行甲泼尼龙治疗、机械通气、气管切开率和住院时间比较，差异均有统计学意义（P＜0.05）。 Logistic 回归分析结果显示，气管切开（OR＝4.345， P＜0.001）、 JOA 评分（OR＝3.213， P＝0.004）、机械通气（OR＝2.375， P＝0.012）、损伤节段（OR＝1.847， P＝0.023）和住院时间（OR＝1.235， P＝0.031）均为颈髓损伤患者HAP的独立影响因素。结论颈髓损伤患者HAP发生率较高，气管切开、 JOA评分、机械通气、损伤节段和住院时间为其影响因素。