探讨出血性脑卒中术后并发肺部感染的影响因素。

回顾性分析2021年6月至2023年3月厦门大学附属中山医院神经外科收治的144例行开颅手术治疗的出血性脑卒中患者，参照肺部感染诊断标准将患者分为感染组和非感染组，感染组24例（16.67%），非感染组120例（83.33%）。采用χ²检验比较2组一般临床资料[年龄、性别、疾病类型、手术方式、吸烟史、格拉斯哥昏迷量表（GCS）评分、高血压病史、糖尿病病史、胃管留置情况、尿管留置情况、术后机械通气情况、营养风险筛查（NRS）2002评分、卧床时间]的差异，采用Logistic多因素回归分析出血性脑卒中患者术后并发肺部感染的独立危险因素。

单因素结果显示，感染组与非感染组患者年龄（≥60岁/<60岁：19/5 vs 6/114）、高血压（75.0% vs 51.7%）、GCS评分（≥9分/<9分：15/9 vs 98/22）、糖尿病（54.2% vs 14.2%）、留置胃管（83.3%% vs 10.8%）、术后机械通气（62.5% vs 8.3%）、NRS2002评分≥3分（91.7% vs 8.3%）、卧床时间（≥3周/<3周：14/10 vs 20/100）比较，差异具有统计学意义（χ²=71.598、4.410、4.349、19.402、55.477、40.901、11.118、19.251，P<0.001、=0.036、=0.037、<0.001、<0.001、<0.001、=0.001、<0.001）；Logistic多因素回归分析显示，年龄≥60岁（OR=1.394，95%CI：1.036~2.002，P<0.001）、糖尿病（OR=1.358，95%CI：1.008~1.692，P=0.004）、术后机械通气（OR=1.485，95%CI：1.183~2.189，P<0.001）、留置胃管（OR=1.236，95%CI：0.993~1.838，P<0.001）均是患者术后并发肺部感染的独立影响因素。

患者年龄≥60岁、高血压、GCS评分<9分、糖尿病、术后机械通气、留置胃管、NRS2002评分≥3分、卧床时间≥3周易导致出血性脑卒中术后并发肺部感染，尤其要注意年龄、糖尿病、术后机械通气、留置胃管方面因素的影响。

To investigate the influencing factors of pulmonary infection after hemorrhagic stroke.

A retrospective analysis was conducted on 144 patients with hemorrhagic stroke treated with craniotomy at the Neurosurgery Department of Zhongshan Hospital Affiliated to Xiamen University from June 2021 to March 2023. They were divided into the infected group and the non-infected group according to the diagnostic criteria for pulmonary infection. The infected group had 24 cases (16.67%) and the non-infected group had 120 cases (83.33%). The difference in general clinical data (age, gender, disease type, operation method, smoking history, GCS score, hypertension history, diabetes history, gastric tube retention, urinary tube retention, postoperative mechanical ventilation, NRS2002 score, general anesthesia, bed time) between the two groups was compared by χ² test, and the independent risk factors of postoperative pulmonary infection in patients with hemorrhagic stroke was analyzed by Logistic regression.

The univariate analyse showed that age (≥60 years old/<60 years old: 19/5 vs 6/114), hypertension (75.0% vs 51.7%), GCS score (≥9 points/<9 points: 15/9 vs 98/22), diabetes (54.2% vs 14.2%), indwelling gastric tube (83.3%% vs 10.8%), postoperative mechanical ventilation (62.5% vs 8.3%), NRS 2002 score ≥3 points (91.7% vs 8.3%) and bed rest time (≥3 weeks/<3 weeks: 14/10 vs 20/100) between the two groups showed statistically significant differences (χ²=71.598, 4.410, 4.349, 19.402, 55.477, 40.901, 11.118, 19.251; P<0.001, =0.036, =0.037, <0.001, <0.001, <0.001, =0.001, <0.001); Logistic regression analysis showed that age ≥ 60 years old (OR=1.394, 95%CI: 1.036-2.002, P<0.001), diabetes (OR=1.358, 95%CI: 1.008-1.692, P=0.004), postoperative mechanical ventilation (OR=1.485, 95%CI: 1.183-2.189, P<0.001), and indwelling gastric tube (OR=1.236, 95%CI: 0.993-1.838, P<0.001) were all independent influencing factors of postoperative pulmonary infection.

Patients with age ≥60 years, hypertension, GCS score<9 points, diabetes, postoperative mechanical ventilation, indwelling gastric tube, NRS2002 score ≥3 points, and bed rest time ≥3 weeks are prone to postoperative pulmonary infection after hemorrhagic stroke. In particular, attention should be paid to age, diabetes, postoperative mechanical ventilation, indwelling gastric tube.