颅脑损伤患者呼吸道感染的特点与危险因素研究

Characteristics and risk factors for respiratory tract infections in patients with craniocerebral injuries

目的了解神经外科颅脑损伤患者发生呼吸道感染后的发病特点,探索导致医院感染的危险因素,为制定有针对性的预防措施提供数据支持。方法选取2010年3月-2012年7月收治的颅脑损伤患者96例,回顾性调查研究发生呼吸道感染的患者临床资料,进行痰液培养病原学检测,确定致病菌;所有数据采用SPSS17.0进行统计分析。结果有33例患者发生下呼吸道感染,感染率为34.4%;共分离出57株病原菌,以革兰阴性菌为主占52.6%,其次为革兰阳性菌占31.6%、真菌占15.8%;高吸烟率78.8%(χ2=5.05,P<0.05)、预防性应用抗菌药物81.8%(χ2=4.00,P<0.05)、有侵入性操作84.8%(χ2=4.78,P<0.05)、住多人房间69.7%(χ2=4.27,P<0.05)、高龄、GCS评分、入住ICU时间长,均为颅脑损伤患者发生呼吸道感染的危险因素。结论神经外科颅脑损伤患者发生呼吸道感染率较高,根据患者入院时的年龄及GCS评分可判断出其是否为发生医院感染的高危人群,应指导临床合理用药加强病房管理,有效降低呼吸道感染的发生率。

OBJECTIVE To investigate the characteristics of respiratory tract infections in the craniocerebral injuries patients of neurosurgery department and explore the risk factors for nosocomial infections so as to provide support‐ing data for development of targeted prevention measures .METHODS A total of 96 patients with craniocerebral in‐juries who were treated in the hospital from Mar 2010 to Jul 2012 were enrolled in the study ,then the clinical data of the patients with respiratory tract infections were retrospectively investigated ,the sputum specimens were cul‐tured for etiological testing so as to determine the pathogenic bacteria ,and the statistical analysis of all the data was performed with the use of SPSS17 .0 software .RESULTS The lower respiratory tract infections occurred in 33 patients ,with the infection rate of 34 .4% .Totally 57 strains of pathogens have been isolated ,of which 52 .6%were the gram‐negative bacteria ,31 .6% were the gram‐positive bacteria ,and 15 .8% were the fungi .The smok‐ing rate （78 .8% ） was high （χ2 =5 .05 ,P〈0 .05） ,81 .8% of the patients used prophylactic antibiotics （χ2 =4 .00 , P〈0 .05） ,84 .8% underwent the invasive operations （χ2 =4 .78 ,P〈0 .05） ,and 69 .7% lived in multi‐patients wards（χ2 =4 .27 ,P〈0 .05） .The advanced age ,GCS score ,and long length of ICU stay were the risk factors for the respiratory tract infections in the patients with craniocerebral injuries .CONCLUSION The incidence of respira‐tory tract infections is high in the patients with craniocerebral injuries ,and the population at high risk of nosoco‐mial infections can be determined on the basis of the age at admission to the hospital and the GCS score .It is an ef‐fective way to guide the reasonable clinical use of antibiotics and strengthen the management of wards so as to re‐duce the incidence of respiratory tract infections .