神经外科患者医院获得性肺炎危险因素的Meta分析

摘要

目的 系统评价神经外科患者医院获得性肺炎的危险因素.方法 检索2001-2016年国内外已发表的有关国内神经外科患者医院获得性肺炎危险因素的文献,选择符合标准的临床研究资料进行Meta分析,计算每个因素的合并OR值.结果 总共7篇文献纳入研究,累计研究对象3 250例.排除发表偏倚的可能,共有8个因素有统计学意义,分别为年龄(OR=1.68,95%CI:1.16~2.11)、气管插管或切开(OR=11.31,95%CI:9.14~13.63)、意识障碍(OR=12.74,95%CI:10.63~15.91)、住院日数(OR=2.36,95%CI:1.42~4.81)、基础疾病(OR=3.17,95%CI:2.18~5.24)、使用呼吸机(OR=2.38,95%CI:1.56~4.32)、营养状况(OR=4.92,95%CI:2.69~6.47)、侵入性操作(OR=2.13,95%CI:1.34~3.86). 结论 年龄、气管插管或切开、意识障碍、住院日数、基础疾病、使用呼吸机、营养状况、侵入性操作神经外科医院获得性肺炎的危险因素,而吸烟、性别、手术类型尚不能确定为神经外科医院获得性肺炎的危险因素.%Objective To systematically evaluate the risk factors for hospital-acquired pneumonia(HAP) in patients in departments of neurosurgery.Methods Literatures about the risk factors for HAP in patients in departments of neurosurgery published at home and abroad between 2001 and 2016 were retrieved, the standard clinical data were selected for Meta analysis, the combined OR value for each factor was calculated.Results A total of 7 literatures (3 250 studied objects) were included in the study.Publication bias was excluded, a total of 8 factors were statistically significant, which including age (OR, 1.68 [95% CI, 1.16-2.11]), endotracheal intubation or tracheotomy(OR, 11.31 [95% CI, 9.14-13.63]), disturbance of consciousness(OR, 12.74 [95% CI, 10.63-15.91]), length of hospital stay(OR, 2.36 [95% CI, 1.42-4.81]), underlying diseases(OR, 3.17 [95% CI, 2.18-5.24]), use of ventilator(OR, 2.38 [95% CI, 1.56-4.32]), nutritional status(OR, 4.92 [95% CI, 2.69-6.47]), and invasive procedure(OR, 2.13 [95%CI, 1.34-3.86]).Conclusion Risk factors for HAP in patients in departments of neurosurgery are age, endotracheal intubation or tracheotomy, disturbance of consciousness, length of hospital stay, underlying diseases, use of ventilator, nutritional status, and invasive procedure.While smoking, gender, and types of surgery are not identified as risk factors for HAP in patients in departments of neurosurgery.