脊髓损伤的创伤患者的呼吸机相关肺炎:脊髓切除术是否会增加风险?
Michael Alchaer1, Ricardo Fonseca1, Leonardo Diaz1
1Department of Surgery, Acute and Critical Care Surgery, Washington University in St Louis, St Louis, Missouri, USA.
Surgical infections
|September 16, 2025
概括
在创伤患者的脊髓切除术没有增加呼吸器相关性肺炎 (VAP) 的风险. 在这项研究中,长时间使用呼吸机,而不是去除脏,是VAP的主要预测因素.
科学领域:
- 创伤外科 手术 创伤外科
- 关键护理医学 关键护理医学
- 传染病流行病学 传染病流行病学
背景情况:
- 在创伤患者的脊髓切除术和感染风险之间的关系是争论的.
- 严重的创伤患者面临着高风险的呼吸机相关肺炎 (VAP).
- 这项研究调查了脊髓切除术是否会增加创伤患者的VAP发病率.
研究的目的:
- 为了确定经过脊髓切除术的创伤患者与脏保存患者相比,VAP的发病率是否更高.
- 为了确定脏损伤的创伤患者中VAP的风险因素.
主要方法:
- 对脊髓损伤患者的创伤登记数据 (2017-2023) 的回顾性审查.
- 纳入标准:入住手术重症监护室,确认脏损伤,损伤严重性评分 (ISS) ≥25,以及≥3天的呼吸机.
- 分为切除术和脏保护组的分层 (栓塞,瘤,观察). 进行了VAP发病率比较.
主要成果:
- 包括140名患者:64名 (46%) 脊髓切除术,76名 (54%) 脊髓保存.
- 无变量分析显示脏维护中的VAP率较高 (32.9%对18.8%),不具有统计学意义 (p=0.059).
- 多变量回归确定了更长的呼吸器日作为一个重要的VAP预测因子 (OR:1.13,p<0.001);脊髓切除术与增加的VAP无关 (OR:0.42,p=0.054).
结论:
- 切除术与此创伤患者队列中VAP发病率的增加没有实质性的关联.
- 长时间的呼吸器持续时间是VAP最强的预测因素.
- 需要进一步的研究,以明确地阐明切除术对创伤患者肺炎风险的影响.
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