重型颅脑损伤患者气管切开术后肺部感染的危险因素分析

Risk factors of pulmonary infections in patients with severe craniocerebral trauma after tracheotomy

目的探讨重型颅脑损伤患者气管切开发生肺部感染的危险因素,为临床预防治疗工作提供参考依据。方法分析2011年1月-2013年12月收治的512例颅脑损伤昏迷气管切开患者临床资料,均予呼吸机辅助呼吸,观察肺部感染情况,分析病原菌种类,调查相关危险因素,数据采用SPSS 18.0软件进行统计分析。结果 512例患者发生肺部感染176例,感染率为34.4%,培养分离出病原菌218株,其中革兰阴性菌159株,占72.9%;对患者进行分析发现,年龄、GCS评分、糖尿病史、长期吸烟史及慢性阻塞性肺疾病史、气管切开时间是肺部感染的主要危险因素(P<0.05)。结论重型颅脑损伤气管切开患者并发肺部感染的主要菌群是革兰阴性菌,危险因素较多,在临床工作中,应采取相应措施减少肺部感染的发生。

OBJECTIVE To investigate the risk factors for pulmonary infections in patients with severe craniocere‐bral trauma after tracheotomy ,so as to provide references for clinical prevention and treatment .METHODS Clinical data of 512 patients with tracheotomy after severe craniocerebral trauma from Jan .2011 to Dec .2013 were ana‐lyzed .These patients were treated with ventilators .The pulmonary infection status was observed to find out the pathogenic bacteria and investigate risk factors . The software SPSS 18 .0 was utilized for statistical analysis . RESULTS Pulmonary infection took place in 176 patients and the infection rate was 34 .4% .Totally 218 strains of pathogenic bacteria were cultured and isolated ,including 159 strains of gram‐negative bacteria （72 .9% ） .The study found that age ,GCS scores ,diabetes history ,long‐term smoking ,chronic obstructive pulmonary disease history ,and tracheotomy time were the risk factors for pulmonary infections （P〈0 .05） .CONCLUSION The main pathogenic bacteria of pulmonary infection in patients with severe craniocerebral trauma after tracheotomy are gram‐negative bacteria .Many risk factors of pulmonary infections are found .Relevant measurements should be taken to prevent or reduce the occurrence of pulmonary infections .