NICU重型颅脑外伤患者肺部感染的临床特点与病原学分析

Clinical characteristics and pathogenic analysis of pulmonary infections in NICU patients with severe brain trauma

目的探讨NICU重型颅脑外伤患者肺部医院感染的病原菌分布与临床特点,以期提高对NICU重型颅脑外伤患者发生肺部感染的特点加深认识,提高临床治疗水平。方法对2011年6月-2013年5月医院NICU165例重型颅脑外伤住院患者进行痰液细菌培养分析,发生感染的35例患者设为感染组,未发生感染的130例患者设为未感染组,比较分析两组患者的临床资料,并总结其病原菌分布与临床特点,采用SPSS 16.0统计软件对数据进行处理。结果重型脑外伤肺部感染患者治疗后脑功能评分为(31.75±8.63)分,显著高于未感染患者的(25.12±9.54)分,且肺部感染患者的病死率22.86%,也显著高于未感染患者的4.62%,差异均有统计学意义(P<0.05);30例患者痰液或呼吸道分泌物共分离鉴定出44株病原菌,其中革兰阴性菌23株占52.27%;革兰阳性菌19株占43.18%;真菌2株占4.55%。结论对重型颅脑外伤患者进行护理过程中应减少侵入性的操作,救治过程应严格无菌操作,检出感染病原菌应根据药敏试验结果给予有针对性的抗菌药物治疗,降低耐药菌株的出现,提高治疗效果。

OBJECTIVE To investigate pathogen distribution and clinical features of nosocomial pulmonary infections in patients with severe brain trauma in hope to deepen the understanding Of characteristics of pulmonary infections in patients with severe brain trauma in neonatal intensive care unit （NICU） so as to improve clinical treatment. METHODS The sputum bacterial culture and analysis was performed for 165 NICU patients with severe brain trauma from Jun. 2011 to May 2013. Thirty-five patients who experienced infections were set as the infection group, while 130 patients with no infection as the noninfection group. Clinical data of the two groups were analyzed and its pathogen distribution and clinical features were summarized. The SPSS 16. 0 statistical software was used for data processing. RESULTS Brain function score and mortality in the infection group （31.75 ±8.63 points, 22.86%） was significantly higher than in the noninfection group （25.12±9.54 points, 4. 62%） （P〈0.05）. Forty-four pathogens were isolated from sputum or respiratory secretions from 30 patients, including 23 gram-negative bacteria accounting for 52. 27%, 19 gram-positive strains accounting for 43.18%, 2 fungus accounti for 4.55%. CONCLUSION Invasive procedures should be reduced in patients with severe brain trauma, and aseptic treatment process should be carried out during the treatment and rescue process. After the detection of pathogen infection, a targeted antibiotic therapy should be based on susceptibility test results to minimize the emergence of resistant strains and improve the therapeutic effect.