97例高血压脑出血颅内血肿微创术后肺部感染分析

Analysis of Pulmonary Infection after Intracranial Hematoma Microinvasive Craniopuncture Scavenging Technique in 97 Patients with Hypertensive Cerebral Hemorrhage

目的探讨急性高血压脑出血患者颅内血肿微创清除术后院内肺部感染的临床特征及防治方法。方法将97例高血压脑出血后行颅内血肿微创清除术的患者按有无院内肺部感染发生分为两组,院内肺部感染组23例,对照组(未发生院内肺部感染)74例,均采集痰液标本进行细菌培养和药物敏感试验,对比分析肺部感染的危险因素和预后。结果术后院内肺部感染率为23.71%,年龄、肺病史、多部位出血及出血量是院内肺部感染的决定因素;感染组患者预后较对照组差,病死率为26.09%,病原体以革兰阴性菌为主,常见细菌为铜绿假单胞菌、大肠埃希菌和金黄色葡萄球菌。结论脑卒中微创术后肺部感染主要与高龄、肺病史及自身出血状况有关;肺部感染后死亡率明显增加,监测病原体、合理选用抗生素有利于院内肺部感染的防治。

Objective To investigate the clinical characters of nosocomial pneumonia in the patients with hypertensive cerebral hemorrhage after intracranial hematoma microinvasive craniopuncture scavenging technique（MPST） and the strategies of prevention and treatment. Methods 97 cases of hypertensive cerebral hemorrhage with MPST were divided into infected group（group A, n=23）and control group without pulmonary infection（group B, n=74）. Sputum was collected for bacteria culture and the drug sensitivity test of isolated bacteria was performed. To compare the risk factors of pulmonary infection. Results In 97 patients, nosocomial pneumonia developed in 23 patients （23.71%）. Age, history of lung disease, muhifocal bleeding and bleeding amount were the decisive factors of pulmonary infection. The prognosis in the infected group was poorer than that of the control group. The mortality rate was 26.09%. The most of microorganisms isolated from respiratory secretion was Gramnegative bacteria. The predominant bacteria were Pseudomonas aeruginosa, E. coli and Staphylococcus aureus. Conclusion Nosocomial pneumonia in the patients with hypertensive cerebral hemorrhage after intracranial hematoma microinvasive craniopuncture scavenging technique is related with age, lung disease and hemorrhage itself. The mortality of the infected patients increases. The preventive and therapeutic strategies for nosocomial pneumonia include surveillance of pathogens and rational use of antibiotics.