發(fā)布時間：2018-07-09 10:02

  本文選題：開顱手術(shù) + 肺炎　； 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:通過對神經(jīng)外科行開顱手術(shù)住院患者的病例資料進(jìn)行回顧性分析,探討開顱術(shù)后肺炎的危險因素,為降低術(shù)后肺炎的發(fā)生率制定預(yù)防策略提供參考依據(jù)。材料與方法:收集2014.1-2015.12廣西醫(yī)科大學(xué)第一附屬醫(yī)院神經(jīng)外科住院行開顱手術(shù)的880例患者進(jìn)行回顧性研究,記錄患者的一般情況和感染相關(guān)因素包括:性別、年齡、身高、體重、吸煙史、胸部X線或CT、術(shù)前合并基礎(chǔ)疾病、手術(shù)類型、失血量、輸血、手術(shù)持續(xù)時間、麻醉ASA分級、手術(shù)分級、術(shù)前住院時間、氣管切開、術(shù)后留置胃管、機(jī)械通氣時間、有無肺炎等。計量資料采用獨立樣本T檢驗,計數(shù)資料采用卡方檢驗對這些變量進(jìn)行單因素分析,若1T5,取校正X2值,篩選出具有統(tǒng)計學(xué)意義的變量,進(jìn)行二分類反應(yīng)變量的非條件多因素logistic回歸分析得出術(shù)后肺炎的獨立危險因素。結(jié)果:開顱術(shù)后發(fā)生肺炎的患者共178例,發(fā)生率為20.23%。經(jīng)單因素分析發(fā)現(xiàn)與以下11個因素相關(guān):年齡、輸血、失血量、急診手術(shù)、氣管切開、.術(shù)后留置胃管、機(jī)械通氣時間≥4h、術(shù)前合并基礎(chǔ)疾病、ASA分級、手術(shù)持續(xù)時間及術(shù)前住院時間。二分類反應(yīng)變量的非條件多因素logistic回歸分析結(jié)果顯示有7個變量為術(shù)后肺炎獨立危險因素,按OR值從大到小排序分別為:氣管切開(OR=27.727,95%CI:2.493-308.348)、術(shù)后留置胃管(OR=4.550,95%CI:2.537-8.161)、急診手術(shù)(OR=4.339,95%CI:1.490-12.631)、機(jī)械通氣時間≥4h(OR=2.806,95%CI:1.369-5.75)、術(shù)前住院時間(OR=1.055,95%CI:1.016-1.095)、年齡(OR=1.027,95%CI:1.013-1.042)、手術(shù)持續(xù)時間(OR=1.004,95%CI:1.002-1.005)。結(jié)論:開顱術(shù)后肺炎發(fā)生率高,為多因素協(xié)同作用所致,主要因素包括年齡、輸血、失血量、急診手術(shù)、氣管切開、機(jī)械通氣時間、術(shù)后留置胃管、術(shù)前合并基礎(chǔ)疾病、ASA分級、手術(shù)持續(xù)時間及術(shù)前住院時間。而氣管切開、術(shù)后留置胃管、急診手術(shù)、機(jī)械通氣時間、手術(shù)持續(xù)時間、年齡及手術(shù)前住院時間是術(shù)后肺炎獨立的危險因素。因此,有效的預(yù)防及控制策略尤為重要。
[Abstract]:Objective: to study the risk factors of pneumonia after craniotomy by retrospective analysis of the data of inpatients undergoing craniotomy in order to provide reference for reducing the incidence of postoperative pneumonia. Materials and methods: a retrospective study was conducted on 880 patients undergoing craniotomy in the Neurosurgery Department of the first affiliated Hospital of Guangxi Medical University from January to May 2014.The general situation of the patients and the related infection factors including sex, age, height, weight were recorded. History of smoking, chest X-ray or CT, preoperative underlying diseases, types of surgery, blood loss, blood transfusion, duration of surgery, anaesthesia ASA grading, surgical grading, preoperative hospitalization, tracheotomy, postoperative gastric tube indwelling, mechanical ventilation time, Pneumonia, etc. The measurement data were tested by independent sample T test, and the counting data were analyzed by chi-square test. If 1T5, the corrected value of X2 was taken to screen out the variables with statistical significance. Non-conditional multivariate logistic regression analysis of two-class response variables was performed to determine the independent risk factors for postoperative pneumonia. Results: there were 178 cases of pneumonia after craniotomy, the incidence was 20.23. Univariate analysis showed that the following 11 factors were correlated: age, blood transfusion, blood loss, emergency surgery, tracheotomy. After operation, the gastric tube was placed, the mechanical ventilation time was more than 4 hours, the preoperative ASA grade, the operative duration and the preoperative hospitalization time were associated with the underlying diseases. Non-conditional multivariate logistic regression analysis showed that 7 variables were independent risk factors for postoperative pneumonia. 鎸塐R鍊間粠澶у埌灝忔帓搴忓垎鍒負(fù):姘旂鍒囧紑(OR=27.727,95%CI:2.493-308.348),鏈悗鐣欑疆鑳冪(OR=4.550,95%CI:2.537-8.161),鎬ヨ瘖鎵嬫湳(OR=4.339,95%CI:1.490-12.631),鏈烘閫氭皵鏃墮棿鈮，

本文編號：2108998