重型颅脑损伤患者合并医院感染临床特点研究

Clinical features of traumatic brain injury with nosocomial infection

目的探讨重型颅脑损伤患者医院感染的临床特点,以加强医院感染预防、控制和管理。方法回顾180例重型颅脑损伤患者的临床资料,观察医院感染发生率、好发部位、病原菌种类、对预后的影响、危险因素。结果医院感染70例(38.89%),呼吸道感染26例、泌尿道感染18例,消化道感染12例、颅内感染10例、其他4例;检出病原菌120株,其中革兰阴性菌53株、革兰阳性菌47株、真菌20株;危险因素包括年龄大、格拉哥昏迷计分低,脱水剂、抑酸剂、激素应用时间长,进行侵入性操作,预防应用抗菌药物;医院感染组中死亡率(28.57%)高于非感染组(10.91%)。结论重型颅脑损伤患者合并医院感染发生率较高,可增加死亡率;应针对感染特征进行预防。

OBJECTIVE To explore the clinical features of severe head injury with nosocomial infection,to strengthen the prevention,control and management of hospital infection.METHODS A retrospective analysis of the clinical data of 180 cases of severe head injury patients was performed,and the incidence of nosocomial infection,location,the prognosis,pathogens and other risk factors were observed.RESULTS Hospital infection were 70 cases（38.89%）,respiratory system infection were 26 cases,urinary tract infection were 18 cases,digestion system infection in 12 cases,intracranial infection were 10 cases,others were 4 cases,120 strains of pathogenic microorganisms were detected,among which,Gram-negative organisms were 53 strains,Gram-positive were 47 strains,fungi were 20 strains,the risk factors included the age,low GCS score,preventive application of antibiotics,acid,hormone application for a long time and invasive operation（P0.05）.The mortality in hospital infection group（28.57%） was higher than that in non nosocomial infection group（10.91%）.CONCLUSIONS The incidence of severe head injury with nosocomial infection is high,which can increase the mortality.The prevention should be performed in accordance with the clinical features.