重型颅脑损伤患者气管切开术后肺部感染特点与危险因素分析

Characteristics of postoperative pulmonary infections in severe brain injury patients undergoing tracheotomy and analysis of risk factors

目的探讨重型颅脑外伤患者气管切开术后肺部感染特点及危险因素,为临床诊治提供参考。方法选取2014年1月-2015年5月264例重型颅脑外伤行气管切开术患者,统计肺部感染率,所有感染患者实施病原学检测,并通过单因素分析及多因素分析对感染危险因素进行分析;采用SPSS 21.0软件对数据进行统计分析。结果 264例气管切开术患者术后64例发生肺部感染,感染率为24.24%;64例患者共分离出102株病原菌,鲍氏不动杆菌和金黄色葡萄球菌为主要病原菌类型;其中鲍氏不动杆菌对亚胺培南耐药率为0,对羧苄西林、头孢哌酮等药物耐药率较高,金黄色葡萄球菌对万古霉素耐药率为0,对庆大霉素等药耐药率较高;不可冲洗型气管套管、营养不良、误吸是肺部感染的危险因素(P<0.05)。结论重型颅脑外伤气管切开患者肺部感染率高,不可冲洗型气管套管、营养不良、误吸是肺部感染的危险因素,耐药机制复杂,临床需加强护理及感染管理,以降低感染率。

OBJECTIVE To explore the characteristics of postoperative pulmonary infections in the severe brain injury patients undergoing tracheotomy and analyze the risk factors so as to provide guidance for clinical diagnosis and treatment.METHODS A total of 264 patients with severe brain injury who underwent the tracheotomy from Jan2014 to May 2015 were enrolled in the study,the incidence of pulmonary infections was taken for statistics,the etiological examination was conducted for all the patients with infections,the univariate analysis and multivariate analysis were carried out for the risk factors,and the statistical analysis of data was performed with the use of SPSS 21.0software.RESULTS Of 264 patients undergoing the tracheotomy,64 had the postoperative pulmonary infections with the infection rate of 24.24%.Totally 102 strains of pathogens were isolated from the 64 patients,among which the Acinetobacter baumannii and Staphylococcus aureus were the predominant species.The drug resistance rate of the A.baumannii to imipenem was 0,and the drug resistance rates to carbenicillin and cefoperazone were high;the drug resistance rate of the S.aureus to vancomycin was 0,and the drug resistance rate to gentamicin was high.The non-rinse tracheal tube,malnutrition,and aspiration were the risk factors for the pulmonary infections（P〈0.05）.CONCLUSIONThe incidence of pulmonary infections is high in the severe brain injury patients undergoing the tracheotomy.The risk factors for the pulmonary infections include the non-rinse tracheal tube,malnutrition,and aspiration.The drug resistant mechanism is so complex that the hospital should strengthen the nursing and infection control so as to reduce the infection rate.