重型颅脑损伤气管切开术后肺部感染的临床干预

Clinical interventions on pulmonary infection in patients with severe craniocerebral injury after tracheotomy

目的探讨重型颅脑损伤患者气管切开后肺部感染的防治措施。方法采用前瞻性和回顾性方法，针对气管切开后肺部感染的危险因素，采取临床干预措施（使用可冲洗气管套管、把握气管套管拔除指征、积极的纤维支气管镜支气管灌洗治疗、合理营养支持和代谢调理、振动排痰机排痰）。结果观察组（实施临床干预）肺部感染率为55．56％（35／63），平均感染控制时间为（6．33±2．71）d；对照组（回顾性分析，未实施临床干预）肺部感染率为72．31％（47／65），平均感染控制时间为（8．44±3．14）d；两组肺部感染率与感染控制时间比较，差异均具显著性（分别Χ^2=3．89，P〈0．05；t=3．19，P〈0．01）。结论经临床干预后，有效降低了重型颅脑损伤患者气管切开后肺部感染率，并缩短了肺部感染控制时间。

Objective To evaluate the measures for preventing and treating pulmonary infection in patients with severe craniocerebral injury after tracheotomy. Methods By prospective and retrospective analysis, clinical intervention measures （use of tracheal tube which can be rinsed, pay attention to the extraction of tracheal tube, active bronchial lavage treatment through fiberbronchoscope, rational nutritional support and regulation of metabolism, sputum excretion by vibrative saliva ejector） were taken according to risk factors of pulmonary infection after tracheotomy. Results In observation group （clinical interventions were taken）, pulmonary infection rate in patients was 55. 56%（35/63）, the average time for controlling infection was （6. 33± 2. 71）d; In control group （clinical interventions were not taken, retrospective analysis）, pulmonary infection was 72. 31%（47/65）, the average time for con- trolling infection was （8. 44 ± 3. 14） d; There were significant difference in pulmonary infection rate and time for controlling infection between two groups （Χ^2= 3. 89, P〈0. 05 ; t = 3. 19,P〈0. 01, respectively）. Conclusion After clinical interventions were taken, pulmonary infection in patients with severe craniocerebral injury after tracheotomy reduced obviously, and time for controlling infection was also shortened.