神经外科ICU患者气管切开后肺部感染的微生物学和临床研究

Clinical and laboratiy study of hospital infection of lung in surgical department of nurve in ICU patients after tracheotomy

目的探讨神经外科ICU患者气管切开后肺部感染的相关因素和感染的病原体及药物敏感性.方法采用前瞻性和回顾性的方法,对1997年1月～2004年5月神经外科ICU患者气管切开后肺部感染的痰培养、药敏试验、ESBL、MRSA、PHRSP的监测和临床资料进行分析,并对铜绿假单胞菌和MRSA进行噬菌体分型.结果该组医院肺部感染发生率89%,大多数出现在气管切开后3～6d,病死率显著高于无医院肺部感染者(P<0.05),共培养出375株优势菌,其中革兰氏阴性杆菌210株、革兰氏阳性球菌86株、真菌79株,3次培养结果一致者按1株计算,79株真菌全部混合细菌感染.结论ICU患者气管切开后肺部感染与应用地塞米松、H2受体拮抗剂及酸泵抑制剂无关,与颅脑损伤程度、医院环境污染、细菌二重感染有关,应在1周内进行痰涂片检菌和培养,根据药敏联合用药.

[Objective] To discuss the relevant factors causing hospital infection of lung in surgical department of nurye of nurve in ICU patients after tracheotomy. [Methods] Using prospective and retrospective studies to analyze during 1997-2004 yuar sputum bacteria cultures, drug sensitive tests and relative vlinical data of 184 cranial injury patients. [Results] Incidence rate of hospital infection of lung was 89% in this group. Most occurred （3.60-0.64） days after tracheotomy The death rate of infected patients was significantly higher than non-infected patients （P 〈 0.05）. There hundred and seventy-five strains of parhogenic bacteria were found of them two hundred and ten gramnegative,eighty-six gram-spostive,seventy-nine fungi, seventy-nine fungi all mix infection with bacteria. [Conclusions] Hospital infection of lung in cranial injury patient after tracheotomy is not relate to use of dexamethasone,H2 receptor antagonist and acid pump inhibitor, but is related to seriousness of cranial injury, environmental pollution of the hospital and infection causing by gram-negative bacteria. Prevention and control should be done within the first week after tracheotomy with active treatment of original disease and use of ICU. Also effective are controlling the environmental pollution of the hospital and selection of antibiotics based on antimicrobial susceptibility testing to control nosocomial.