颅内血肿清除术后气管切开患者肺部感染因素研究

Risk factors for pulmonary infections in patients undergoing tracheotomy after intracranial hematoma removal

目的探讨颅内血肿清除术后气管切开肺部感染的危险因素、预后状况及干预对策。方法选择2012年1月-2016年1月医院接诊的245例颅内血肿清除术后行气管切开术的患者,分析发生肺部感染的危险因素,并提出针对性的干预对策。结果 245例患者中有49例发生肺部感染,感染率为20.0%;肺部感染与昏迷时间、年龄、气管切开时间、吸烟史、吸痰液、侵入性操作具有相关性;其中脑挫裂伤感染发生肺部感染率最高,其次为硬膜下血肿、硬膜外血肿;共分离49株病原菌,其中革兰阴性菌占73.47%,革兰阳性菌占22.45%,真菌占4.08%。结论在颅内血肿清除术后行气管切开术引起肺部感染的原因较多,在临床上应给予相应的措施,积极控制感染,在提高预后方面具有积极意义。

OBJECTIVE To explore the risk factors for pulmonary infections in patients undergoing tracheotomy after intracranial hematoma removal, analyze the status of prognosis, and put forward the intervention countermeasures. METHODN A total of 245 patients who underwent the traeheotomy after intracranial hematoma removal from Jan 2012 to Jan 2016 were enrolled in the study. The risk factors for the pulmonary infections were analyzed, and the targeted intervention countermeasures were proposed. RESULTS Of the 245 patients, 49 had the pulmonary infections, with the infection rate 20.0%. The incidence of the pulmonary infections was associated with the time of coma, age, tracheostomy time, smoking history, suction sputum, and invasive operations. The incidence of pulmonary infections was highest in the patients with cerebral contusion and laceration, followed by the patients with subdural hematoma and the patients with epidural hematoma. Totally 49 strains of pathogens were isolated, of which 73. 47% were gram-negative bacteria, 22. 45% were gram-positive bacteria, and 4. 08% were fungi. CONCLUSION There are a variety of risk factors for the pulmonary infections in the patients undergoing tracheotomy after intracranial hematoma removal. It is of positive significance for the hospital to take corresponding measures to actively control the infections so as to improve the prognosis.