重型颅脑损伤患者气管插管内呼吸机相关临床病原学的研究

Clinical bacteriological study in severe craniocerebral injury under mechanical ventilation with tracheal intubation

目的 :了解重型颅脑损伤气管插管内呼吸机相关病原学问题。方法 :对 30例重型颅脑损伤患者在拔除气管插管时 ,以插管套管内、口腔、螺纹管内分泌物进行细菌学研究 ,并作统计学处理。结果 :1在 30例重型颅脑损伤病例中气管插管内有 5 6 %患者出现致病菌 ;2病原菌以 G- 杆菌为主 ,但真菌上升至第 2位 ;3在重型颅脑伤病情中 ,随病情加重〔即格拉斯哥昏迷评分 (GCS)评分下降〕,致病菌发生率会增加 ;4特重型颅脑伤致病菌发生率明显高于重型颅脑伤 ;5插管的时间长短与并发肺炎的早晚无确定关系。结论 :1在重型颅脑伤患者气管插管中均可产生较高比率的致病菌 ;2预防重型颅脑伤所致的肺炎应选择 G-杆菌敏感抗生素 ;3预防真菌感染及机内消毒是一个重要措施 ;4及时拔管 ,变更通气方式 。

Objective:To investigate ventilator related pathogens in severe craniocerebral injury patients with tracheal intubation.Methods:Thirty severe craniocerebral injury cases were entered the study.Bacterial cultures were taken from the tracheal tubes,mouth and threadtube at the time of extubation,and the data were analysed statistically.Results:Pathogenic bacteria were found in 56% of 30 cases with severe craniocerebral injury with intubation.The dominant pathogens were Gramnegative bacteria,with fungi ranking the second. In severe craniocerebral injury patients,the incidence of positive culture increased with worsening of patients′ condition, i.e .Glasgow coma scale(GCS) getting lower.In patients with very severe craniocerebral injury, the incidence of positive culture was even higher than severe craniocerebral injury.The duration of intubation had no relation with the onset of pneumonia.Conclusions:High rate of positive bacterial culture occurs after intracheal intubation in severe craniocerebral injury.To prevent pneumonia in patients with severe craniocerebral injury,potent antibiotic against Gramnegative bacteria should be used.It is important to prevent the fungus infection and to disinfect the interior of the ventilator.It is advantageous to extubate timely,and to change the ventilating mode in order to reduce the bacterial infection.