重型颅脑损伤患者肺部感染的危险因素及综合防治

Risk Factors and Comprehensive Control of Pneumonia in Patients with Severe Head Injury

目的探讨颅脑外科重症监护病房(ICU)重型颅脑损伤患者肺部感染的危险因素以及发生率,感染类型,菌群变化等因素,为预防及控制提供基础,更好达到综合防治的目的。方法对2004年1月-2009年6月625例重型颅脑损伤患者出现肺部感染的危险因素综合分析。结果该病例医院感染率为35.04%,引起肺部感染有显著临床意义的危险因素有高龄、昏迷时间长短、气管切开、休克、基础病等。年龄>60岁,昏迷时间>1周,有气管切开,留置胃管,有吸烟史及应用激素治疗均能显著增加肺部感染发生率。结论针对危险因素,对高龄患者昏迷时间长有吸烟史以及行气管切开患者加强支持治疗,应用20%白蛋白及丙种球蛋白辅助治疗及时行痰培养,指导临床用药,尽量减少激素应用,对留置鼻胃管患者行微创胃造瘘术改变进食途径,避免因反流所致反复肺部感染,同时加强肠内外营养。经综合防治有效控制肺部感染,提高治愈率。

Objective To study the risk factors,incidence,infection types and changes of microbial flora of nosocomial pneumonia of severe head injury in order for better multiple treatment.Methods In our hospital from January 2004 to June 2009,625 cases of nosocomial pneumonia of severe head injury in neurosurgery intensive care unit（NICU） were selected.The risk factors and multiple treatment effects were discussed.Results The nosocomial infection rate was 35.04%.The risk factors of nosocomial pneumonia included senile,coma time,tracheotomy,shock and basal disease and so on.Age60 years,duration of coma1 week,with tracheotomy,indwelling stomach tube,a smoking history and application of hormone therapy can significantly increase the incidence of pulmonary infection.Conclusion For risk factors,support treatment should be strengthened to the elderly patients who had coma for a long time and history of smoking or tracheotomy;20% albumin and gamma globulin should be applicated,sputum culture should be made in order to adjuvant clinical treatment in time,the hormone application should be minimized.To patients underwent indwelling nasogastric tube gastrostomy minimally invasive way should be performed to change the eating to avoid regurgitation and recurrent pulmonary infection,enteral nutrition need to be enhanced.The cure rate could be improved by integrated control and effective control of Pneumonia.