NSICU下呼吸道感染病例危险因素分析

Risk factors of lower respiratory tract infections in patients in neurosurgery ICU

目的探讨神经外科重症监护病房发生下呼吸道感染的危险因素。方法采用前瞻性调查与回顾性调查相结合的方法对2013年1—12月的NSICU住院病人进行调查登记。结果 NSICU发生下呼吸道感染83例次。基础病以重型颅脑损伤和脑血管意外为主;平均住院时间为43.83 d;平均年龄为59.49岁,>60岁占56.63%;手术55例,均采用静脉复合麻醉;气管插管/切开83例,机械通气67例;病原菌检出98株,特殊耐药菌检出41株,鲍曼不动杆菌均占首位。结论住院时间长、病情危重、高龄患者是NSICU下呼吸道感染的高发人群。手术创伤及侵袭性操作是感染发生的主要诱因。鲍曼不动杆菌已成为医院下呼吸道感染的重要致病菌。

Objective This article aimed to investigate the risk factors of lower respiratory tract infections in patients in neurosurgery ICU （ NICU） .Methods Prospective and retrospective methods were used to investigate the patients hospitalized in NICU during January 2013 and December 2013.Results A total of 83 patients in NICU had lower respiratory tract infection.Those patients were mainly underlying severe brain damage and cerebral vascular accident.The average length of stay of them was 43.83d.Their average age was 59.49 years old.55 patients of them used intravenous anesthesia.There were 83 cases of tracheal intubation or tracheotomy and 67 cases of mechanical ventilation.Totally 98 pathogens were isolated.There were 67 strains of mechanical ventilation.Special resistant bacteria were detected in 41 cases, mainly of them were bauman acinetobacter.Conclusions Long length of hospital stay, critical condition and old age were high risks for respiratory infections of NSICU patients.Surgical trauma and invasive procedures were main predisposing factors for Lower respiratory tract infections.Acinetobacter baumannii had become important hospital pathogens for lower respiratory tract infection.