神经外科气管切开院内肺炎感染的治疗对策

Analysis and treatment countermeasures for patients with hospital acquired pneumonia infection after undergoing neurosurgery tracheotomy surgery

目的:探讨预防及控制神经外科气管切开术后发生获得性肺炎的措施及治疗对策。方法:对2006年1月-2011年12月神经外科62例行气管切开术患者发生获得性肺炎的资料进行回顾性分析。结果 :痰培养革兰氏阴性菌29例,革兰氏阳性菌22例,真菌感染7例。革兰阴性杆菌对亚胺培南的敏感性最高。革兰阳性菌对万古霉素的敏感性最高。真菌对氟康唑敏感。62例患者中死亡2例、放弃治疗5例、植物生存6例、转院1例,治愈48例,肺感染症状多在2～3周控制。结论:通过加强消毒隔离措施及气道护理,根据药敏试验联合使用抗菌药物是预防与控制气管切开术发生获得性肺炎的重要手段。

Objective： To analyze and explore treatment countermeasures for hospital acquired pneumonia infection in patients undergoing neurosurgery tracheotomy.Methods： Data of 62 patients with acquired pneumonia after undergoing routine tracheostomy during January 2006 and December 2011 were retrospectively analyzed.Results： Culture of the sputum revealed gram negative bacteria infection in 29 cases,gram-positive bacteria in 22 cases,and fungal infection in 7 cases.Gram negative bacilli showed the highest sensitivity to imipenem,while gram positive bacteria have the highest sensitivity to vancomycin.Fungi were most sensitive to fluconazole.Of the 62 patients,2 were dead,5 gave up treatment,6 were in vegetative states.One case were transferred to other hospital,48 were cured.Average course of lung infection ranged between 2-3 weeks.Conclusions： Strengthening measures of sterilization and isolation,intensive airway care as well as drug sensitivity test combining with antimicrobials is the key to prevent and control acquired pneumonia after undergoing tracheostomy.