重型创伤性脑损伤患者术后发生重度肺部感染的相关危险因素及预测效能分析  

Analysis of risk factors and predictive efficacy for postoperative severe pulmonary infection in patients with severe traumatic brain injury

作　　者：熊雨轩 才智 廖晋 张复驰 赵恺[1] 牛洪泉[1] 舒凯[1] 雷霆[1] Xiong Yuxuan;Cai Zhi;Liao Jin;Zhang Fuchi;Zhao Kai;Niu Hongquan;Shu Kai;Lei Ting(Department of Neurosurgery,Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院神经外科,武汉430030

出　　处：《中华创伤杂志》2024年第5期405-410,共6页Chinese Journal of Trauma

基　　金：湖北省病理生理学会面上项目(2021HBAP007)。

摘　　要：目的探讨重型创伤性脑损伤(sTBI)患者术后发生重度肺部感染(SPI)的独立危险因素并评估其预测价值。方法采用回顾性队列研究分析2021年4月至2023年3月华中科技大学同济医学院附属同济医院收治的163例sTBI患者的临床资料,其中男101例,女62例;年龄20~80岁[53.0(46.0,59.0)岁]。手术方式包括去骨瓣减压术、硬膜下血肿清除术、硬膜外血肿清除术、脑内血肿清除术。按照患者术后是否发生SPI分为SPI组(62例)和非SPI组(101例)。收集两组性别、年龄、术前格拉斯哥昏迷评分(GCS)、血糖升高、肝功能异常、肾功能异常、血红蛋白含量、贫血、白蛋白含量、低蛋白血症、白细胞计数、中性粒细胞计数、淋巴细胞计数、血小板计数、中性粒细胞/淋巴细胞比值(NLR)、间接中性粒细胞/淋巴细胞比值(dNLR)、血小板/淋巴细胞比值(PLR)、预后营养指数(PNI)和血清乳酸脱氢酶(LDH)水平,以上血液学检查均在患者术前未经抗炎治疗时抽取静脉血完成。通过单因素和多因素逐步回归分析筛选sTBI患者术后发生SPI的独立危险因素。通过受试者工作特征(ROC)曲线并计算曲线下面积(AUC),评估各指标单独或联合对sTBI患者术后发生SPI的预测价值。结果单因素分析结果显示,两组术前GCS、白蛋白含量、淋巴细胞计数、NLR、PNI及血清LDH水平与sTBI患者术后发生SPI有一定的相关性(P<0.05),而两组性别、年龄、血糖升高、肝功能异常、肾功能异常、血红蛋白含量、贫血、低蛋白血症、白细胞计数、中性粒细胞计数、血小板计数、dNLR和PLR与sTBI患者术后发生SPI不相关(P>0.05)。多因素逐步回归分析结果表明,低淋巴细胞计数(95%CI-0.337,-0.013,P<0.05)、高NLR(95%CI-0.023,-0.005,P<0.01)、低PNI(95%CI 0.007,0.026,P<0.01)和高血清LDH水平(95%CI-0.002,-0.001,P<0.01)是sTBI患者术后发生SPI的独立危险因素(P<0.05)。ROC曲线分析显示,低淋巴细胞计Objective To investigate the independent risk factors for postoperative severe pulmonary infection(SPI)in patients with severe traumatic brain injury(sTBI)and evaluate their predictive value.Methods A retrospective cohort study was conducted to analyze the clinical data of 163 sTBI patients admitted to Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology from April 2021 and March 2023,including 101 males and 62 females,aged 20⁃80 years[53.0(46.0,59.0)years].The surgical procedures involved decompressive craniectomy,subdural hematoma removal,epidural hematoma removal,and intracranial hematoma removal.The patients were divided into SPI group(n=62)and non⁃SPI group(n=101)according to whether they had SPI postoperatively.The following data of the two groups were collected,including gender,age,preoperative Glasgow coma scale(GCS),elevated blood glucose,abnormal liver function,abnormal renal function,hemoglobin level,anemia,albumin level,hypoproteinemia,white blood cell count,neutrophil count,lymphocyte count,platelet count,neutrophil⁃to⁃lymphocyte ratio(NLR),derived neutrophil⁃to⁃lymphocyte ratio(dNLR),platelet⁃to⁃lymphocyte ratio(PLR),prognostic nutritional index(PNI)and serum lactate dehydrogenase(LDH)level.All the hematological tests were performed on venous blood samples collected preoperatively before anti⁃inflammatory treatment.Independent risk factors for predicting the postoperative occurrence of SPI in sTBI patients were identified through univariate analysis and multivariable stepwise regression analysis.The predictive value of separate indicator or indicators combined was assessed by calculating the area under the curve(AUC)of the receiver operating characteristic(ROC)curve.Results Univariate analysis demonstrated that preoperative GCS,albumin level,lymphocyte count,NLR,PNI and serum LDH level in both groups were significantly correlated with the postoperative occurrence of SPI(P<0.05),while gender,age,elevated blood glucose,abnormal liver function,abnorm

关 键 词：脑损伤 乳酸脱氢酶类 肺炎 营养复合指数 

分 类 号：R651.15[医药卫生—外科学]