神经外科危重症病人下呼吸道感染病原菌分布及高危因素分析

Distribution of pathogenic bacteria in lower respiratory tract infection and its risk factors in critical ill patients of neurosurgery

[目的]了解神经外科危重症病人并发下呼吸道感染者的病原菌分布及高危因素。[方法]选择2013年9月—2016年2月在我院神经外科诊治的创伤性脑损伤病人128例,观察下呼吸道感染发生情况并进行病原菌的分离鉴别,分析导致下呼吸道感染的高危因素。[结果]128例病人中并发下呼吸道感染28例,发生率为21.9%;25例病人检出病原菌,检出率为89.3%,共检出病原微生物36株,其中革兰阴性菌25株,革兰阳性菌10株,真菌1株;单因素分析结果显示年龄、使用广谱抗生素、体重指数、淋巴细胞计数、吸烟、气管插管、深静脉穿刺置管对神经外科危重症病人并发下呼吸道感染有影响(P<0.05);Logistic多因素回归分析结果显示使用广谱抗生素、体重指数、气管插管、淋巴细胞计数为神经外科危重症病人并发下呼吸道感染的主要独立危险因素(P<0.05);并发下呼吸道感染病人90d后死亡率(46.4%)高于无并发下呼吸道感染病人(3.0%),两者比较差异有统计学意义(χ2=9.194,P=0.000)。[结论]神经外科危重症病人并发下呼吸道感染比较多见,以革兰阴性菌占优势,使用广谱抗生素、体重指数、气管插管、淋巴细胞计数为主要的危险因素,在临床上需要加强护理管理。

Objective To probe into the distribution of pathogenic bacteria in lower respiratory tract infection and its risk factors in critical patients of neurosurgery. Methods：A total of 128 traumatic brain injury patients in our hospital receiving diagnosis and treatment of from September 2013 to February 2016 were selected,the occurrence of lower respiratory tract infection was observed and carried out isolation and identification of pathogenic bacteria,analyzed high-risk factors leading to lower respiratory tract infection. Results： There were 28 cases with lower respiratory tract infection in 128 cases,the incidence was 21. 9%. 25 cases of pathogenic bacteria were detected, the detection rate was 89. 3%. A total of 36 pathogenic microorganisms were detected, including 25 Gram - negative bacteria, Gram - positive bacteria 10,1 fungi. The results of univariate analysis showed： age, use of broad - spectrum antibiotics,body mass index,lymphocyte count,smoking,tracheal intubation,deep vein catheterization had influence on neurosurgical critically ill patients complicated with lower respiratory tract infection（P〈0 . 05）. The logistic multivariate regression analysis showed that the main independent risk factors were broad - spectrum antibiotics,body mass index, tracheal intubation and lymphocyte count for lower respiratory tract infection in critically ill patients with neurosurgery（P〈0 . 05）. The mortality rate（46. 4%） of patients complicated with lower respiratory tract infection was higher than that of patients without lower respiratory tract infection（3. 0%） after 90 days. There was statistically significant difference between both groups（χ^2 = 9. 194, P - 0. 000）. Conclusions： Neurosurgical critically patients complicated with lower respiratory tract infection were more common,especially Gram -negative bacteria. The usage of broad -spectrum antibiotics,body mass index, tracheal intubation, lymphocyte count were the main risk factors, and nursing management need to be strengthened in clinic.