脊柱手术住院患者术后肺部感染危险因素logistic回归分析

摘要

Objective To understand the risk factors for postoperative pulmonary infection in patients undergoing spinal surgery,and put forward the intervention measures.Methods Patients who underwent spinal surgery in a hospital from May 2008 to June 2016 were analyzed retrospectively,they were divided into non-pulmonary infection group and pulmonary infection group according to whether they had postoperative pulmonary infection,clinical data of two groups were compared.Results A total of 612 patients who underwent spinal surgery were monitored,43 had postoperative pulmonary infection,incidence of postoperative pulmonary infection was 7.03％.Univariate analysis showed that 14 risk factors for pulmonary infection in patients after spinal surgery were as follows:length of hospital stay≥30 days,long-term smoking,chronic pulmonary disease,diabetes,number of surgical level≥2,general anesthesia,duration of operation≥4 hours,bleeding≥500mL,time of bed rest≥7 days,use of glucocorticoid,indwelling urinary catheter,mechanical ventilation,serum albumin＜30 g/L,blood glucose≥1 1mmol/L,and hemoglobin＜90 g/L(P＜0.05);while atomization inhalation was a protective factor(P＜0.05).Multivariate logistic regression analysis showed that 6 independent risk factors for pulmonary infection in patients after spinal surgery were as follows:length of hospital stay≥30 days,long-term smoking,chronic pulmonary disease,general anesthesia,time of bed rest≥7 days,and use of glucocorticoid(all P＜0.05),while atomization inhalation was a independent protective factor(P＜0.05).Conclusion Patients with pulmonary infection after spinal surgery is related to multiple factors,comprehensive and effective preventive measures should be taken according to the risk factors of postoperative pulmonary infection,so as to reduce the incidence of postoperative pulmonary infection in spinal surgery patients.%目的 了解脊柱手术住院患者术后肺部感染的危险因素,以针对性地提出干预措施.方法 回顾性分析某院2008年5月-2016年6月脊柱手术住院患者,按术后是否发生肺部感染分为无肺部感染组和肺部感染组,比较两组临床资料.结果 共监测脊柱手术住院患者612例,其中术后发生肺部感染43例,术后肺部感染发生率为7.03％.单因素分析显示,患者住院时间≥30 d、长期吸烟、有慢性肺部疾病、有糖尿病、手术节段数≥2、全身麻醉、手术时间≥4h、出血量≥500 mL、卧床时间≥7d、使用糖皮质激素、留置导尿管、机械通气、血清清蛋白＜30 g/L、血糖≥11 mmol/L、血红蛋白＜90 g/L共14个因素是脊柱手术住院患者术后发生肺部感染的危险因素(P＜0.05),而雾化吸入是保护因素(P＜0.05).多因素logistic回归分析显示,住院时间≥30d、长期吸烟、有慢性肺部疾病、全身麻醉、卧床时间≥7d、使用糖皮质激素共6个因素均是脊柱手术住院患者术后肺部感染的独立危险因素(均P＜0.05),而雾化吸人是脊柱手术住院患者术后肺部感染的独立保护因素(P＜0.05).结论 脊柱手术住院患者术后肺部感染与多种因素有关,临床应针对术后肺部感染的危险因素,采取综合有效的预防措施,才能降低脊柱手术住院患者术后肺部感染发生率.