重症颅脑损伤患者发生感染性肺炎危险因素及护理

The risk factors associated with pulmonary infection and its nursing countermeasures in patients with severe traumatic brain injury

目的探究重症颅脑损伤患者发生感染性肺炎的危险因素及其护理对策。方法对58例重症颅脑损伤并发感染性肺炎患者的临床资料进行回顾性分析。结果选择2011年5月-2013年5月上虞市人民医院收治的173例重症颅脑损伤患者,其中发生感染性肺炎有58例,感染率为33.5%。高龄、住院时间≥20d、呼吸机运用、气管切开、休克、基础病、抗生素激素滥用等为引起重症颅脑损伤患者发生感染性肺炎有统计学意义的危险因素,差异有统计学意义(χ2=11.1,P<0.001;χ2=10.06,P=0.002;χ2=11.3,P<0.001;χ2=9.432,P=0.002;χ2=11.1,P<0.001;χ2=4.02,P=0.045)。性别与肺部并发感染没关系(P>0.05)。其中各危险因素的危险程度由高到低为呼吸机应用、高龄、休克、气管切开、住院时间≥20d、基础病。革兰阴性菌占病原菌的主要部分(76.6%)。结论重症颅脑损伤发生感染性肺炎与多种危险因素有关,针对相应的危险因素采取有效的护理措施可降低感染率。

Objective To explore the risk factors and nursing countermeasures of pulmonary infection in patients with severe traumatic brain injury. MethodWe conducted a retrospective analysis on the clinical data of 58 patients with severe traumat- ic brain injury complicated by pulmonary infection. Result One hundred and seventy- three patients with severe traumatic brain injury received treatment in the People＇s Hospital of Shangyu City between May 2011 and May 2013, of which 58 were in- fected with infectious pneumonia, with the infection rate of 33.5 %. Senility, hospitalization ≥20 d, application of respiratory equipment, tracheotomy, shock, underlying disease and antibiotics and hormone abuse were the significant risk factors affecting prevalence of pulmonary infection in patients with severe traumatic brain injury, and the differences were statistically significant （X^2=l1.1 P〈0.001;X^2= 10.06, P=0.002;X^2=11.3, P〈0.001;X^2=9.432, P=0.002,X^2=11.1, P〈0.001;X^2 = 4.02, P = 0. 045）. There was no correlation between gender and pulmonary infection （P 〉 0.05）. The degree of risk of the above- mentioned risk factors from high to low were application of respiratory equipment, senility, shock, tracheotomy, hos- pitalization ≥20 d and underlying disease. Gram negative bacteria were the predominant pathogenic bacteria （76.6 % ）. Con- clusions Occurrence of pulmonary infection in Severe traumatic brain injury is correlated with a variety of risk factors, and hence, implementing effective nursing interventions aimed at the related risk factors can reduce the infection rate.