重型颅脑损伤患者术后肺部感染的原因分析与护理

目的分析重型颅脑损伤患者术后肺部并发感染的原因,以便提出有效的护理对策。方法分别于患者术后第1d、3d、5d取呼吸道分泌物进行培养,并分析肺部感染因素。结果①肺部感染情况:绿脓杆菌感染29例(48.3%),肺炎克雷伯杆菌感染17例(28.3%),白色念珠菌感染14例(23.3%)。②肺部感染原因:患者病情重,发病后机体防御机能降低;患者由于意识障碍,咳嗽反射迟钝,呕吐物或颅底骨折所致的出血、漏出的脑脊液、口咽部及气管分泌物不能完全排出;患者有不同程度的吞咽困难,易引起误吸;各种侵入性操作相对较多使细菌带入体内的机会增多等。结论加强重症监护病房的管理、保持呼吸道通畅、湿化呼吸道、做好吸痰及气管切开等护理能有效预防重型颅脑术后肺部感染发生。

Objective To analyze the causes of post,operative pulmonary infection in heavy head injured patients and bring forward effective nursing countermeasure. Methods The secretion from patients' respiratory tract was taken for culture 24 hours, 72 hours and 120 hours after operation. The factors that influenced pulmonary infection were analyzed. Results Pathogens of pulmonary infection were as following: pyocyanic infection (29 cases, 48.3%), klebsiella pneumoniae infection (17 cases, 28.3%), and candida albicans infection (14 cases, 23.3%). The causes related to pulmonary infection included serious illness and reduced body defense system, consciousness disorder and dullness of cough,reflex, difficulty swallowing and invasive operation. Conclusions It can effectively prevent the postoperative pulmonary infection in patients with heavy head injury through the reinforced management of ICU, keeping the respiratory tract unobstructed, moistening of respiratory tract, drainage of phlegm and tracheotomy.[