摘要目的 探讨影响脑海绵状血管畸形(CCM)患者术后肺炎发生的相关因素.方法 回顾性收集福建医科大学附属第一医院神经外科自2010年1月至2017年1月收治的151例CCM患者的临床资料,根据是否发生术后肺炎将患者分为术后肺炎组(n=11)和术后无肺炎组(n=140).采用单因素、多因素Logistic回归分析和受试者工作特征(ROC)曲线筛选影响CCM患者术后肺炎发生的相关因素及评估相关因素对术后肺炎的预测价值.结果 与术后无肺炎组患者相比,术后肺炎组患者的改良Rankin量表(mRS)评分及CCM伴出血比例明显升高,格拉斯哥昏迷量表(GCS)评分明显降低,差异均有统计学意义(P<0.05).多因素Logistic回归分析表明术前GCS评分(OR=4.75,95％CI:1.14～19.80,P=0.032)和mRS评分(OR=15.61,95％CI:3.22～75.58,P=0.001)为影响术后肺炎发生的独立相关因素.ROC曲线分析显示,mRS评分≥4分预测术后肺炎的灵敏度和特异度分别为45.5％和95.7％,GCS评分≤13分预测术后肺炎的灵敏度和特异度分别为54.5％和85.7％.结论 对术前GCS评分≤13分或mRS评分≥4分的CCM患者,需要更加注重围手术期肺部管理,警惕术后肺炎的发生.

abstractsObjective To explore the related factors affecting postoperative pneumonia in patients with cavernous cerebrovascular malformation (CCM).MethodsClinical data of 151 CCM patients admitted to our hospital from January 2010 to January 2017 were retrospectively collected. Patients were divided into postoperative pneumonia group (n=11) and postoperative non-pneumonia group (n=140) according to the occurrence of postoperative pneumonia. Univariate Logistic regression analysis, multivariate Logistic regression analysis and receiver operating characteristic (ROC) curve were used to screen the relevant factors influencing the occurrence of postoperative pneumonia in CCM patients and evaluate the predictive value of relevant factors in postoperative pneumonia.ResultsAs compared with patients from postoperative non-pneumonia group, patients from postoperative pneumonia group had significantly increased modified Rankin scale (mRS) scores and significantly higher percentage of CCM combined with hemorrhage, and significantly decreased Glasgow coma scale (GCS) scores (P<0.05). Multivariate Logistic regression analysis showed that preoperative GCS scores (OR=4.75, 95％CI: 1.14-19.80,P=0.032) and mRS scores (OR=15.61, 95％CI: 3.22-75.58,P=0.001) were independent factors influencing the occurrence of postoperative pneumonia. ROC curve showed that the sensitivity and specificity of mRS scores≥4 to predict postoperative pneumonia were 45.5％ and 95.7％, respectively, and the sensitivity and specificity of GCS scores≤13 to predict postoperative pneumonia were 54.5％ and 85.7％, respectively.ConclusionFor CCM patients with preoperative GCS scores≤13 or mRS scores≥4, more attention should be paid to perioperative lung management and occurrence of postoperative pneumonia should be vigilant.