PNEUMONIA FOLLOWING CLOSED HEAD-INJURY
PNEUMONIA FOLLOWING CLOSED HEAD-INJURY
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DOI：
10.1164/ajrccm/146.2.290
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发表时间：
1992-08-01
期刊：
影响因子：
--
通讯作者：
PIERSON, DJ
中科院分区：
文献类型：
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作者：
HSIEH, AHH;BISHOP, MJ;PIERSON, DJ
肺炎在有人工气道的病人中很常见。 大多数先前对此类肺炎的研究涉及一组异质性患者，通常患有重大内科或外科疾病。 我们研究了一组孤立性闭合性颅脑损伤（CHI）患者的肺炎发病率，以确定在没有其他损伤的情况下该问题的模式，并确定这些患者的肺炎发展模式是否与更异质的机械通气患者组相当。 我们研究了109名最初昏迷的孤立性CHI患者，他们通气24小时或更长时间。 平均年龄为30.3 ± 20.2岁，72%为男性，入院时格拉斯哥昏迷评分为4.9 T ± 1.4。 总体而言，45例患者（41%）发生肺炎，大多数（29/45）发生在住院的前3天。 第一周后没有病人发生肺炎，尽管事实上许多人仍然通气，其他人仍然插管，还有一些人拔管但昏迷。 发生肺炎的患者的ICU住院时间（10.5 +/- 5.4天vs 7.2 +/- 4.3天，p = 0.001）和住院时间（34.8 +/- 27.6天vs 22.5 +/- 20.2天，p = 0.01）更长。 我们的结论是：（1）CHI与肺炎的高发病率有关;（2）CHI患者肺炎的发生早于其他患者组，表明病因可能不同;（3）CHI患者肺炎不倾向于在住院第一周后发生;（4）CHI患者拔管不倾向于导致肺炎;（5）CHI患者肺炎加重ICU及住院时间。
Pneumonia is common among patients with artificial airways in place. Most prior studies of such pneumonia involve a heterogeneous group of patients, usually with major medical or surgical illnesses. We studied the incidence of pneumonia in a group of patients with isolated closed head injury (CHI) in an effort to determine the pattern of the problem in the absence of other injuries and to determine whether the pattern of development of pneumonia in these patients was comparable to that in more heterogeneous groups of mechanically ventilated patients. We studied 109 initially comatose patients with isolated CHI who were ventilated 24 h or more. The mean age was 30.3 +/- 20.2 yr, 72% were male, and the admission Glasgow coma score was 4.9T +/- 1.4. Overall, 45 patients (41%) developed pneumonia, with the majority (29/45) occurring during the first 3 days of hospitalization. No patient developed pneumonia after the first week despite the fact that many were still ventilated, others remained intubated, and yet others were extubated but comatose. Patients who developed pneumonia experienced a longer ICU stay (10.5 +/- 5.4 days versus 7.2 +/- 4.3 days, p = 0.001) and hospital stay (34.8 +/- 27.6 versus 22.5 +/- 20.2 days, p = 0.01). We concluded that (1) CHI is associated with a high incidence of pneumonia; (2) pneumonia occurs earlier in CHI than in other patient groups, suggesting that the etiology may be different; (3) pneumonia does not tend to occur after the first week of hospitalization in CHI; (4) extubation of CHI patients did not tend to lead to pneumonia; and (5) pneumonia prolongs ICU and hospital stay in CHI patients.