重度颅脑外伤患者医院感染的临床特点观察

Observation on clinical features of severe brain injury patients with nosocomial infection

目的了解重度颅脑外伤患者医院感染的临床特点,为预防与控制神经外科病房医院感染提供依据。方法对276例重度颅脑外伤医院感染患者的病原菌培养结果进行回顾性分析,调查感染部位与原发疾病、感染部位与并发症、留置导尿管与泌尿道感染、气管切开术与下呼吸道感染的关系及病原菌分布。结果 276例重度颅脑外伤和123例患有基础疾病患者发生医院感染的部位,均以下呼吸道、中枢神经系统和泌尿道感染为主,分别占34.78%、29.35%、18.12%和40.65%、30.89%、17.89%;未留置导尿管患者泌尿道感染率为10.78%,显著低于留置导尿管患者22.41%,差异有统计学意义(P<0.05);行气管切开患者发生下呼吸道感染率为37.65%,显著低于未行气管切开患者79.31%,差异有统计学意义(P<0.05);共检出355株病原菌,其中革兰阳性菌95株占26.76%,革兰阴性菌242株占68.17%,真菌18株占5.07%。结论通过观察感染部位、原发疾病、治疗手段、病原菌的分布,可确立合理的治疗方案,有利于控制医院感染。

OBJECTIVE To find out the clinical features of severe brain injury patients with nosocomial infection, so as to provide survey data for the prevention and control of hospital infections in neurosurgery ward. METHODS The microbiological eulture samples test results of 276 cases of severe traumatic brain injury patients with nosocomial infection were analyzed retrospectively. The relationship of infection sites to primary diseases, infection sites to complications, indwelling catheter to urinary tract infections, tracheotomy to lower respiratory tract infections and pathogen distribution were investigated. RESULTS The main infection sites were lower respiratory tract, central nervous system and urinary tract to the 276 cases of severe brain injury patients and 123 cases of patients in nosocomial infection, infection rates for severe brain injury patients accounting for 34.78%, 29.35% and 18. 12%, infection rates for nosocomial infection patients accounting for 40. 65%, 30. 89% and 17.89%. The urinary tract infection rate of patients with no indwelling catheter was 10. 78%, obviously lower than 22.41% to patients with indwelling catheter, and the difference had statistical significance （P〈0.05）. The rate of lower respiratory tract infections in patients with traeheotomy was 37.65 %, significantly lower than those who did not undergo tracheotorny79, al% （P〈0.05）. A total of 355 strains of pathogenic bacteria, among which 95 strains were Gram-positive bacteria, accounting for 26.76 %, 242 strains of Gram-negative bacteria, accounting for 68.17%, 18 strains of fungi 5. 07%. CONCLUSION By the observation of infection site, primary disease, treatment method and the distribution of pathogens, rational treatment options can he established, and nosocomial infections can be controlled.