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

Pathogen distribution and risk factors of pulmonary infection after acute cervical spinal cord injury

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.