重症监护室气管切开术后下呼吸道感染相关因素研究

Investigation of correlation factor in lower respiratory tract infection after tracheotomia in ICU

目的探讨重症监护室（ICU）气管切开术后下呼吸道感染的相关因素。方法对20例气管切开前采集患者颈部皮肤，切开后第1天、第5天、第10天、第15天分别采集下呼吸道痰液、切口处、口腔、咽部、病房空气、物体表面、吸引器引流管、呼吸机管道接口处、呼吸机湿化瓶、气管切开套管内及护理人员手部共12处，样本送细菌室检测及培养。采用Stata9．0统计应用软件对临床资料和检测结果分别进行分析。结果气管切开术后下呼吸道医院感染发生率95％，术后不同时间下呼吸道感染率不同（P〈0．01）。不同时间呼吸道病原菌分布与仪器管道、患者口腔、咽部、气管切口处呈正相关（P〈0．05或P〈0．01），与护理人员手部、空气、物体表面无明显相关。结论ICU气管切开术后下呼吸道感染发生率高，感染高发时间为术后10d以内；术后下呼吸道感染除患者自身因素外，与以呼吸机为主的仪器管道关系密切。

Objective To study the correlation factors in lower respiratory tract infections after tracheotomia in ICU. Methods 20 patients were accepted. We gathered the samples on skin of neck before tracheotomia, and gathered 12 samples on buccal cavity, professional jargon, pharyngeal portion secretion, sputum at lower respiratory tract, ward atmosphere, article surface, drainage tube, pipeline interface of breathing machine, humidification bottle, tracheostomy cannula and hands of nurse, respectively, at the first day, fifth day, tenth day and fifteenth day after tracheotomia. And then the relationship of kinds of factors and lower respiratory tract infection was analyzed by Chi-square criterion and Spearman rank correlation analysis of Stata 9.0 statistics softwave. Results The rate of lower respiratory tract infection was 95%, and the results were not same at indifferent times （ P 〈 0. 01 ）. Spearman rank correlation analysis showed that distribution of pathogenic bacteria in respiratory tract at different times had positive correlation with equipment pipeline, oral cavity, pharyngeal portion and incision of trachea, and had no obvious correlation with hands of nurse, ward atmosphere and article surface. Conclusions The patients after tracheotomia have an higher incidence rate on lower respiratory tract infection in ICU, especially within 10 days. Lower respiratory tract infection after tracheotomia has close relationship with equipment pipeline, mainly such as ventilator, in addition to the patients＇ self-factors.