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急性颈脊髓损伤后肺部感染致病菌分布特点及影响因素分析 被引量:7

Pathogen distribution and risk factors of pulmonary infection after acute cervical spinal cord injury
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摘要 目的探讨急性颈脊髓损伤(ACSCI)后肺部感染致病菌分布特点和影响因素,为早期抗感染治疗提供临床依据。方法选择2011年10月-2014年10月收治的ACSCI并发肺部感染患者223例,其中男149例,女74例;年龄(43.3±13.5)岁。根据致病菌的检出类型定义为革兰阳性菌感染(仅检出革兰阳性菌)、革兰阴性菌感染(仅检出革兰阴性菌)及混合菌感染(检出2株及以上致病菌),分析年龄、性别、损伤类型及气管切开对肺部感染的影响。结果223例患者中革兰阴性菌感染114例(51.1%),气管切开率为7.0%,病死率为1.8%,主要致病菌为肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌。革兰阳性菌感染41例(18.4%),气管切开率为12.2%,死亡率为7.3%,主要致病菌为金黄色葡萄球菌、肺炎链球菌。混合菌感染68例(30.5%),气管切开率为22.1%,病死率为13.2%。性别对肺部感染类型分布影响差异无统计学意义(P〉0.05)。完全性损伤和气管切开患者混合感染比例显著升高(P〈0.05)。年龄≤30岁患者中,革兰阳性菌感染比例显著升高(P〈0.05)。结论ACSCI后肺部感染主要为革兰阴性菌感染,而年龄≤30岁患者革兰阳性菌感染风险高,完全性损伤及气管切开患者混合感染风险高。 Objective To investigate the pathogen distribution and risk factors of pulmonary infection after acute cervical spinal cord injury (ACSCI) in an attempt to offer reference for early anti- infection therapy. Methods The study comprised 223 cases who were admitted from October 2011 to October 2014. There were 149 males and 74 females, at (43.3 ± 13.5) years of age. Species of pathogens identified were gram-positive, gram-negative and mixed. Effects of age, gender, injury types and tracheotomy on pathogen distribution were analyzed. Results Gram-negative infection was found in 114 cases (51.1%) , with tracheotomy accounting for 7.0% of the cases and death accounting for 1.8% of the cases, and the main causative pathogens were Klebsiella pneumonia, Escherichia coli, Pseudomonas aeruginosa and Acinetobacter banmannii. Gram-positive infection was found in 41 cases (18.4%), with tracheotomy accounting for 12.2% of the cases and death accounting for 7.3% of the cases, and the main causative pathogens were Staphylococcus aureus and Streptococcus pneumonia. Mixed infection was found in 68 cases (30.5%) , with tracheotomy accounting for 22.1% of the cases and death accounting for 13.2% of the cases. Gender had no significant correlation with pathogen distri- bution. For the cases of complete spinal cord injury and tracheotomy, the ratio of mixed infection increased significantly ( P 〈 0.05 ). For the cases younger than 30 years, the pathogens were mainly gram-positive bacteria ( P 〈 0. 05 ). Conclusions Main pathogens of pulmonary infection after ACSCI are gram-negative bacteria. The cases younger than 30 years are associated with higher risk of gram- positive infection, while the cases with complete injury or tracheotomy are associated with higher risk of mixed infection.
出处 《中华创伤杂志》 CAS CSCD 北大核心 2016年第5期449-452,共4页 Chinese Journal of Trauma
基金 国家自然科学基金(81572194,81371383) 上海市“曙光计划”项目(13SG38)
关键词 脊髓损伤 肺疾病 病原菌 Spinal cord injuries Lung diseases Pathogen
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参考文献11

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