The Relationship Between Preoperative Gastrointestinal Decompression And Postoperative Aspiration Pneumonia After Hypertensive Intracerebral Hemorrhage

Objective: To investigate the relationship between preoperative gastrointestinal decompression and postoperative aspiration pneumonia after hypertensive intracerebral hemorrhage and to explore the possibility of reducing postoperative aspiration pneumonia by preoperative gastrointestinal decompression.Methods: 1.A retrospective analysis of 146 patients with hypertensive intracerebral hemorrhage who underwent craniotomy between January 2017 and July 2018 was included.The patients were divided into two groups according to whether there was preoperative gastrointestinal decompression or not.The incidence of postoperative aspiration pneumonia was compared before and after the removal of confounding factors by propensity score matching.We hypothesized that preoperative gastrointestinal decompression could reduce the incidence of aspiration pneumonia in high-risk patients.2.Univariate and multivariate logistic regression analysis was used to test the risk factors for the occurrence of postoperative aspiration pneumonia in patients without preoperative gastrointestinal decompression.We drew a nomogram to predict the probability of the postoperative aspiration pneumonia.A ROC curve was used to verify its predictive value.The high-risk patients were determined according to the prediction results of nomogram and the actual incidence of postoperative aspiration pneumonia.3.Expanded collection of 229 patients between January 2017 and November 2019.The patients with high risk of postoperative aspiration pneumonia were screened through the nomogram.The incidence of postoperative aspiration pneumonia was compared between the gastrointestinal decompression group and the no gastrointestinal decompression group.Results: 1.Among 146 patients,37(25.3%)received preoperative gastrointestinal decompression.The incidence of aspiration pneumonia was 10.8%(4/37)in the preoperative gastrointestinal decompression group and 25.6%(28/109)in the no preoperative gastrointestinal decompression group,P=0.059.After using propensity score matching to remove the confounding factors,37 pairs of patients in the two groups were matched successfully.After matching,the incidence of aspiration pneumonia in the no preoperative gastrointestinal decompression group was 35.1%(13/37),the difference was statistically significant,P= 0.013.2.The results of univariate Logistic regression analysis showed that the history of stroke,preoperative fasting time,cerebral hemorrhage score,neutrophil to lymphocyte ratio,blood glucose level were related to the incidence of aspiration pneumonia,P< 0.05.The results of multivariate logistic regression analysis showed that the history of stroke,fasting time less than 8 hours and high score of cerebral hemorrhage score were independent risk factors of the postoperative aspiration pneumonia,P< 0.05.The prediction value of the prediction model is tested by using the ROC curve after drawing the three risk factors into a nomogram.Its AUC area is 0.892 which means a high prediction value.combining the prediction results of nomogram with the actual aspiration pneumonia in the cases,the patients with the prediction probability of more than 50% of the nomogram were identified as high-risk patients.3.A total of 108 patients with more than 50% incidence of aspiration pneumonia were screened out by nomogram between January 2017 and November 2019.There were 46 cases in the group of preoperative gastrointestinal decompression,the incidence of aspiration pneumonia was 13.0%(6/46).There were 62 cases in the no preoperative gastrointestinal decompression group,the incidence of aspiration pneumonia was 46.7%(29/62).The difference between the two groups was statistically significant,P< 0.05.Conclusion: Preoperative gastrointestinal decompression could reduce the incidence of aspiration pneumonia in high-risk patients after hypertensive intracerebral hemorrhage,but it was not applicable to all patients.High-risk patients can be screened by three risk factors: whether the patients had a history of stroke,whether the preoperative fasting time was less than 8 hours and the actual score of cerebral hemorrhage score.After plotting the three factors into a nomogram,the patients with a prediction probability of more than 50% were high-risk patients.