ICU气管切开患者肺部感染的危险因素分析及干预对策

Risk factors of pulmonary infections in patients undergoing tracheotomy in ICU and intervention countermeasures

目的分析重症监护病房(ICU)行气管切开发生肺部感染的危险因素,以及时干预,为下一步气管切开预防肺部感染提供依据。方法选取在2009年4月-2012年6月入住ICU因需创辅助呼吸机患医源性肺炎的患者180例为研究对象,术后定期予以痰培养+药敏,且对相应患者予以胸片检查;对患者的各种接触因素进行标本采集,以致病菌为线索,对诸因素进行评价,作出各因素对医源性肺炎的综合指数。结果病原菌的种数随时间在不断变异,随着时间的推移,病原菌的种数在不断增加,气管切开的肺部感染90例,感染率达50.0%,时间主要在术后约6d,以革兰阴性菌为主;采用logistic分析,发现呼吸湿化瓶、呼吸机接口、吸引器连接管处的病原菌与患者肺部感染呈正相关,即为肺部感染的危险因素。结论重症病房气管切开患者,感染发生在氧管切开后约1周,感染以革兰性阴性菌为主,危险因素以呼吸湿化瓶、呼吸机接口、吸引器连接管为主,随时间延长,细菌耐药性较高。

OBJECTIVE To identify the risk factors of pulmonary infections induced by tracheotomy in intensive car unit （ICU） so as to take timely intervention to prevent the pulmonary infections. METHODS A total of 180 cases of patients with iatrogenic pneumonia, who were enrolled the ICU for the treatment with invasive assisted breath- ing machine from Apt 2009 to Jun 2012, were selected as the study objects, the sputum culture and the drug susceptibility testing were carried out after the surgery, and the chest X-ray examination was performed. The various contact factors were taken for specimen collection, and the pathogens were set as the clues, and the various factors were taken for evaluation. The composite indexes of all factors of hospital pneumonia were set. RESULTS The species of the pathogens varied with the time, showing an increasing trend with the time. The pulmonary infections occurred in 90 cases with the incidence rate of 50. 0%, the pulmonary infections mainly occurred 6 days after the surgery, and the gram-negative bacteria were dominant. The logistic analysis indicated that the incidence of pulmonary infections was positively correlated with the pathogens in the respiratory humidifi- cation bottle, ventilator interface, or suction connecting tube, which were the risk factors of the pulmonary infec- tions. CONCLUSION For the patients undergoing tracheotomy, the pulmonary infections occur about one week after the surgery, and the gram-negative bacteria are the predominant pathogens causing the infections. The respiratory humidifier bottle, ventilator interface, and suction and connection tube are the main risk factors of the pulmonary infections. The bacterial resistance is increasing along with the time.