颅脑损伤气管切开患者医院感染危险因素分析

Risk Factors of Hospital Infection among Patients of Brain Injury after Tracheotomy:Analysis and Prevention

目的探讨颅脑损伤气管切开患者医院感染危险因素,以便采取有效预防与控制措施。方法对医院2005年12月-2006年12月在颅脑外科住院的50例颅脑损伤气管切开患者进行了前瞻性和回顾性调查分析,并对病原学标本进行了细菌培养和药敏试验。结果50例患者中发生医院感染33例次,医院感染例次率为66.0%,以下呼吸道感染为主,其次为手术伤口感染;病原菌中以革兰阴性杆菌为主共45株占81.8%,其次革兰阳性球菌10株占18.2%,这些菌对常用抗菌药物均有不同程度的耐药性,且多药耐药呈上升趋势;气管切开患者医院感染与侵入性操作、不合理使用抗菌药物等密切相关。结论颅脑损伤气管切开术后感染率高是多因素影响的结果,合理应用抗菌药物、加强无菌技术操作、提高患者自身免疫力,可降低医院感染发病率,提高治愈率。

OBJECTIVE To analyze the risk factors of hospital infection among patients of brain injury after tracbeotomy and provide the basis for the prevention and controlling the hospital infection. METHODS A prospective and retrospective methods were adopted to investigate 50 cases of patients of brain injury after tracheotomy who were admitted into the department of cerebral surgery in our hospital, from Dec 2005 to Dec 2006, the specimens from the patients were cultured, and the susceptivity test was done. RESULTS Among the 50 patients, 33 patients occurred nosocomial infection. The infectious sites were mostly in lower reaspiratory tract and postoperative wound. The pathogens mainly were Gram-negative bacilli with 45 strains （81.1%）, next were Gram-positive cocci with 10 strains （18.2%）, and they showed different resistance to commonly used antibiotics, especially this trend was raising. Nosocomial infection of patients with tracheal incision was nearly related with invasive manipulation and abuse of antibiotics. CONCLUSIONS The high rate of nosocomial infection among patients of brain injury after tracheotomy could attribute to muhiple factors, and in order to reduce the rate and improve the cure rate, it is very important to use antibiotic rationally, strengthen sterile operation, and improve the immunity of the patients.