脊髓损伤住院康复患者尿路感染相关危险因素回顾性分析

关键词：脊髓损伤  尿路感染  危险因素

Keywords:spinal cord injury  urinary tract infection  risk factors

摘要：

      摘要 目的：了解脊髓损伤（spinal cord injury， SCI）住院康复患者尿路感染（urinary tract infection，UTI）相关危险因素，为SCI患者UTI管理提供参考。 方法：回顾性分析2017年1月—2021年12月中国科学技术大学附属第一医院（安徽省立医院）康复医学科576例SCI患者。收集入院时信息包括：自变量[性别、年龄、损伤原因、损伤部位、ASIA分级（美国脊髓损伤协会分级标准，American Spinal Cord Injury Association，ASIA分级）、是否手术、是否保留导尿、是否并发症（肺部感染及神经源性膀胱）、是否贫血（女：血红蛋白<110g/L，男：血红蛋白<120g/L）和血常规（血红蛋白水平、红细胞计数及血小板计数）]，因变量（是否并发UTI）。根据是否并发UTI分为两组，比较基线资料情况并应用多元logistic回归分析自变量与因变量的关系。 结果：405（70.31%）例患者并发UTI。并发UTI者血红细胞计数（P<0.001）要低于无UTI者。并发UTI者手术治疗、保留导尿、神经源性膀胱及肺部感染比率高于无UTI者（P<0.001）。两组患者SCI损伤原因（P<0.001）、ASIA分级（P<0.001）、性别（P=0.008）构成比差异具有显著性意义，而损伤部位（P=0.080）、年龄（P=0.102）和是否贫血（P=0.648）构成比差异无显著性意义。保留导尿（OR=3.718）和神经源性膀胱（OR=4.559）是UTI的独立危险因素（OR>1，P<0.05）；增加血RBC计数（OR=0.675）、ASIA-D级（相对于ASIA-A级）（OR=0.515）以及损伤原因为非外伤（相对于外伤）（OR=0.587）是UTI保护因素（OR<1，P<0.05）。 结论：行康复治疗的SCI患者，住院期间发生UTI可能与保留导尿、神经源性膀胱、ASIA分级较高及损伤原因为外伤有关。拔除导尿管，治疗神经源性膀胱，以及促RBC生成治疗可能会有助于降低UTI发生率。

Abstract:

      Abstract Objective： To determine the risk factors and provide references for the management of urinary tract infection （UTI） in patients with spinal cord injury（SCI） hospitalized for rehabilitation. Method： Retrospective analysis of 576 patients with SCI from the Department of Rehabilitation of the First Affiliated Hospital of the University of Science and Technology of China（Anhui Provincial Hospital） from January 2017 to December 2021.The information collected on admission includes： independent variables[sex， age， modes of injury， location of injury， ASIA grades（American spinal cord injury association， ASIA grades）， surgery， indwelling urethral catheter（IUC）， complications （pulmonary infection and neurogenic bladder）， anemia（female： level of hemoglobin<110g/L， male： level of hemoglobin<120g/L）and blood routine test（hemoglobin level， red blood cells[RBC] count and platelets[PLT] count ）] and dependent variable（complications of incidence of UTI）. We divided patients into two groups according to whether they were diagnosed as UTI， and then compared the baseline between two groups， and then relationship between independent variables and dependent variable was analyzed by the multivariate logistic regression. Result： 405（70.31%） patients were complicated with UTI. RBC count （P<0.001） in patients complicated with UTI was lower than those without UTI. Surgical treatment， IUC， neurogenic bladder and pulmonary infection were higher in patients complicated with UTI than those without UTI （P<0.001）. There were statistically significant differences in the ratio of modes of injury（P<0.001）， ASIA grades（P<0.001） and sexes（P=0.008） between two groups， while there was no significant difference in the location of injury（P=0.080）， age（P=0.102） and anemia（P=0.648）. IUC （OR=3.718） and neurogenic bladder （OR=4.559） were independent risk factors for UTI （OR>1， P<0.05）； Increasing RBC counts （OR=0.675）， ASIA-D grade （OR=0.515， relative to ASIA-A grade） and non-traumatic reason of SCI（OR=0.587， relative to traumatic reason of SCI） were protective factors for UTI （OR<1， P<0.05）. Conclusion： UTI in patients with SCI hospitalized for rehabilitation may be associated with IUC， neurogenic bladder， higher ASIA grades and traumatic reason of SCI. Removing urinary catheter， treating neurogenic bladder and RBC-promoting therapy may be helpful to reduce the incidence of UTI.