重症颅脑损伤气管切开患者肺部感染的治疗研究

Treatment of pulmonary infections in severe craniocerebral injury patients undergoing tracheotomy

目的研究重症颅脑损伤患者气管切开并发肺部感染的治疗方案,旨在改善患者的肺部感染症状。方法选取2011年1月-2014年12月100例重症颅脑损伤行气管切开并发肺部感染患者为研究对象,将患者随机分为观察组与对照组,每组各50例,对照组按照常规方法给予抗感染治疗、雾化吸入、吸痰及营养支持等综合性治疗,观察组在对照组基础上通过纤维支气管镜进行支气管灌洗疗法,观察肺部感染患者痰培养的病原菌分布,治疗两周后通过临床症状与实验室检查对两组患者的治疗效果进行评估;采用SPSS 17.0软件对数据进行统计分析。结果 100例患者共分离出病原菌174株,其中革兰阴性菌146株占83.9%,革兰阴性菌28株占16.1%,主要病原菌为铜绿假单胞菌和鲍氏不动杆菌,分别占24.1%和20.1%;治疗两周后,两组患者的体温、白细胞计数、肺部啰音、痰液培养结果、病灶吸收状况均得以显著改善,观察组患者的改善程度显著优于对照组,两组比较差异有统计学意义(P<0.05);观察组患者的治疗总有效率为94.0%,显著高于对照组的78.0%,两组比较差异有统计学意义(P<0.05)。结论重症颅脑损伤患者气管切开并发肺部感染的病原菌以革兰阴性菌为主,在常规综合治疗基础上实施支气管灌洗疗法可以显著提升其治疗效果。

OBJECTIVE To investigate the treatment plans for the severe craniocerebral injury patients complicated with pulmonary infections undergoing tracheotomy so as to improve the symptom of pulmonary infections in the patients.METHODS A total of 100 severe craniocerebral injury patients complicated with pulmonary infections who underwent the tracheotomy from Jan 2011 to Dec 2014 were recruited as the study objects and randomly divided into the observation group and the control group,with 50 cases in each.The control group was treated with conventional comprehensive therapies such as anti-infection therapy,atomization,sputum suction,and nutrition support;the observation group was given additional bronchoalveolar lavage therapy through bronchofibroscope based on the treatment of the control group.The distribution of pathogens cultured from sputum specimens was observed,the curative effects of the two groups of patients were evaluated through the clinical symptoms and laboratory examination after the treatment for two weeks,and the statistical analysis of data was performed with the use of SPSS17.0software.RESULTS Totally 174 strains of pathogens were isolated from 100 patients,including 146（83.9%）strains of gram-negative bacteria and 28（16.1%）strains of gram-negative bacteria;the Pseudomonas aeruginosa and Acinetobacter baumannii were the predominant species of pathogens,accounting for 24.1% and 20.1%,respectively.After the treatment for 2weeks,the body temperature,white blood cell counts,pulmonary rale,condition of sputum culture,and condition of focus absorption were remarkably improved,and the observation group was improved more significantly than the control group（P〈0.05）.The total effective rate of treatment of the observation group was 94.0%,significantly higher than 78.0% of the control group（P〈0.05）.CONCLUSIONThe gram-negative bacteria are dominant among the pathogens causing the pulmonary infections in the severe craniocerebral injury patients undergoing the tracheotomy.The implementation of bronchoalveolar lavage therapy based on the conventional therapy can significantly improve the curative effect.