小儿重型颅脑损伤患者医院感染临床特点研究

An analysis of clinical characteristics of severe traumatic brain injury with nosocomial infection in children

目的探讨小儿重型颅脑损伤患者救治过程中医院感染的临床特点,为医院感染的预防控制和管理提供参考。方法回顾分析90例小儿重型颅脑损伤患者的临床资料,统计医院感染部位及感染菌株种类的构成,对比观察医院感染组及无医院感染组患者的危险因素。结果 90例小儿重型颅脑损伤患者中继发医院感染36例,感染率为40.00%;感染部位构成的顺位依次为呼吸道、泌尿道和消化道。感染的菌株种类以G-菌和G+菌为主。格拉斯哥昏迷评分(GCS)低、入住ICU时间长、脱水剂应用时间长、开放性损伤、合并多发伤、侵入性操作以及不合理应用抗生素是医院感染的危险因素(P均<0.01)。感染组患儿病死率显著高于非感染组(P<0.05)。结论小儿重型颅脑损伤患者医院感染发生率较高,感染后可增加患儿致残致死率;GCS、入住ICU时间、脱水剂应用时间及开放性创伤、合并多发伤、侵入性操作、不合理应用抗生素等是医院感染的重要因素,临床应针对感染因素进行积极预防。

Objective To investigate the treatment of pediatric patients with severe craniocerebral injury of nosocomial in- fection in clinical features, for the prevention of nosocomial infection control and management to provide reference. Methods The clinical materials of 90 cases of severe craniocerebral injury in children patients were analyzed retrospectively, the statistical analysis of the nosocomial infection and infection species were performed, and the risk factors of hospital infec- tion in hospital infection group and non-nosocomial infection group were observed. Results Hospital infection was 36 cas- es, the infection rate was 40.00%; the sites of infection were respiratory tract, urinary tract and gastrointestinal tract. The types of infection species were G- bacterium and G＋ bacteria. The risk factors included the low GCS score, the long time in ICU, the dehydrating agent application for a long time, the opened injury complicated with multiple injuries, the invasive operation and the unreasonable application of antibiotics （P 〈 0.01）. The mortality in hospital infection group was ignifi- cantly higher than that in non-nosocomial infection group （P 〈 0.05）. Conclusion The pediatric patients with severe head injury are higher in nosocomial infection, which can increase the disability and death rate： The GCS score, the time in ICU, the dehydrating agent application, the opened injury complicated with multiple injuries, the invasive operation and the un- reasonable application of antibiotics are important factors for the nosocomial infection. The prevention should be active per- formed in accordance with the clinical infection factors.