重症颅脑损伤患者气管切开术后气道细菌学分析与临床护理

BACTERIOLOGICAL ANALYSIS AND CLINICAL NURSING AFTER PATIENTS OF SEVERE CRANIOCEREBRAL INJURY RECEIVING TRACHEOTOMY

目的分析气管切开术后患者下呼吸道感染、致病菌分布情况和护理效果。方法对我院神经外科35例重症颅脑损伤行气管切开人工气道通气病人的呼吸道分泌物进行细菌学及耐药性检验,实施相应的治疗与护理措施。结果首次细菌学检验有23例分离出致病菌,阳性率65.7%,其中革兰氏阴性杆菌17例,占73.9%。35例共行细菌学检验94例次,获得阳性结果79例次,送检阳性率达84.04%,拔管前每周1次共64次细菌学检验中,阴性8例次,占12.5%,单纯细菌感染52例次,二重感染1例次,细菌、真菌混合感染3例次,气道内致病菌种类以革兰氏阴性杆菌为主,铜绿假单胞菌为首位。头孢他啶,阿米卡星联合用药后,35例患者呼吸道感染治愈16例,显效12例,好转3例,无效4例。临床有效率80.0%,细菌学评价,有效病例细菌培养转阴22例,细菌清除率78.5%。结论重症颅脑损伤病人气管切开术后,可致下呼吸道致病菌定植,易致呼吸道感染,采取细菌学检验并根据药敏进行用药和护理措施的实使,可以有效地预防和控制感染。

Objective To explore the infections of lower respiratory tract and the distribution of pathogens after patients receiving tracheotomy and the effects of nursing measures. Methods 35 cases of severe craniocerebral injury underwnet trancheotomy and the secretion of respiratory tract was examined. Bacteriological and drug resistance tests were conducted. The treatments and nursing measures were evaluated. Results Pathogens were detected in 23 cases with the positive rate being 65.7%, and gram-negative bacilli were found in 17 cases （73. 9 % ）. 94 bacteriological tests were performed and 79 tests （84.24 % ） found positive results. 64 tests performed once a week before decannulation discovered 8 negative results（ 12.5 % ）, 52 baeterial infections, one double infection,3 mixed infections caused by bacteria and fungi. Gram-negative bacilli, especially verdingris pseudomonas, were the main pathogens in air passage. The combined use of ceftadime and amikacir produced good effects. 16cases recovered. 12 cases got good effects. 3 eases got improved and 4 cases got no effects. The clinical rate was 80.0%. 22 cases （78.5%） of the 35 eases got negative results after treatments. Conclusion After patients with severe craniocerebral injury received tracheotomy , pathogensmay reproduce in.,the lower respiratory tract to cause respiratory infections. Bacteriological and drug resistance tests can be performed and good nursing measures can be taken to prevent and control infections.