颅脑损伤患者气管切开术后肺部感染危险因素的Meta分析  

Meta-analysis of risk factors for lung infection in patients with craniocerebral injury after tracheotomy

作　　者：叶磊 屈蕊 张爱琴 Ye Lei;Qu Rui;Zhang Aiqin(Department of Critical Care Medicine,Jinling Hospital Affiliated to Medical School of Nanjing University(General Hospital of the Eastern War Zone),Nanjing 210002,China;Key Specialty of Clinical Nursing,Jinling Hospital Affiliated to Medical School of Nanjing University(General Hospital of the Eastern War Zone),Nanjing 210002,China)

机构地区：[1]南京大学医学院附属金陵医院(东部战区总医院)重症医学科,210002 [2]南京大学医学院附属金陵医院(东部战区总医院)临床护理重点专科,210002

出　　处：《中华现代护理杂志》2020年第3期350-355,共6页Chinese Journal of Modern Nursing

摘　　要：目的通过Meta分析探讨颅脑损伤患者气管切开术后肺部感染的危险因素,为预防肺部感染提供科学依据。方法制订文献纳入和排除标准,设计检索策略,由2名研究人员独立检索Cochrane Library、EMBASE、PubMed英文数据库(以brain injury/craniocerebral injury/traumatic brain injury/tracheotomy/lung infection/pulmonary infection/risk factors/influencing factor/promotive factor为关键词),检索CNKI、万方数据库、维普网中文数据库(以颅脑损伤/颅脑创伤/脑外伤/气管切开/肺部感染/下呼吸道感染/危险因素/影响因素/相关因素为关键词),检索时限自建库至2019年4月28日。进行文献质量评价后,采用RevMan 5.3进行数据分析。结果最终纳入9篇文献,包括2112例颅脑损伤患者。Meta分析结果显示,糖尿病[OR=3.36,95%CI(2.49,4.54),P<0.01]、使用激素[OR=2.52,95%CI(1.83,3.45),P<0.01]、格拉斯哥昏迷量表(GCS)评分[OR=2.92,95%CI(1.95,4.37),P<0.01]、低蛋白血症[OR=3.18,95%CI(2.20,4.60),P<0.01]、误吸[OR=3.18,95%CI(2.24,4.51),P<0.01]、吸烟[OR=1.87,95%CI(1.16,3.00),P<0.01]、不可冲洗气管套管[OR=2.54,95%CI(1.71,3.77),P<0.01]、气管切开时间(>7 d)[OR=2.32,95%CI(1.42,3.79),P<0.01]是颅脑损伤患者气管切开术后肺部感染发生的影响因素。结论现有证据表明,合并糖尿病、使用激素、GCS评分高、低蛋白血症、发生误吸、使用不可冲洗气管套管、吸烟、气管切开时间>7 d是颅脑损伤患者气管切开术后肺部感染发生的独立危险因素。Objective To analyze the risk factors for lung infection in patients with craniocerebral injury after tracheotomy through Meta-analysis and provide a scientific reference for its prevention.Methods The inclusion and exclusion criteria were determined and the search strategies were designed.Two researchers independently searched both English and Chinese databases such as Cochrane Library,EMBASE,PubMed,CNKI,Wanfang and VIP(taking brain injury,craniocerebral injury,traumatic brain injury,tracheotomy,lung infection,pulmonary infection,risk factor,influencing factor and promotive factor as the key words)for literatures published since the databases were built to April 28th,2019.RevMan 5.3 was used to analyze the data after the quality of literatures were assessed.Results Totally 9 articles were included,including 2112 patients with craniocerebral injury.Meta-analysis showed that diabetes[OR=3.36,95%CI(2.49,4.54),P<0.01],use of hormones[OR=2.52,95%CI(1.83,3.45),P<0.01],Glasgow Coma Scale(GCS)score[OR=2.92,95%CI(1.95,4.37),P<0.01],hypoproteinemia[OR=3.18,95%CI(2.20,4.60),P<0.01],aspiration[OR=3.18,95%CI(2.24,4.51),P<0.01],smoking[OR=1.87,95%CI(1.16,3.00),P<0.01],non-irrigable tracheal cannula[OR=2.54,95%CI(1.71,3.77),P<0.01]and tracheotomy time(>7 d)[OR=2.32,95%CI(1.42,3.79);P<0.01]were the influencing factors for lung infection in patients with craniocerebral injury after tracheotomy.Conclusions Existing evidence shows that combined with diabetes,use of hormones,high GCS score,hypoalbuminemia,occurrence of aspiration,use of non-irrigable tracheal cannula,smoking,tracheotomy time>7 d were independent risk factors for lung infection in patients with craniocerebral injury.

关 键 词：颅脑损伤 META分析 气管切开术 危险因素 肺部感染 

分 类 号：R473.6[医药卫生—护理学]