烧伤患者医院获得性肺炎的病原学特点及危险因素分析

Pathogenic characteristics and risk factors of hospital acquired pneumonia in burned patients

目的探究烧伤患者医院获得性肺炎(HAP)的病原学特点并对其危险因素进行分析,为临床医师在治疗和院内获得性肺炎的相关预防上提供一定的参考依据。方法选择2012年1月-2015年7月在医院收治的烧伤患者1 320例,对医院获得性肺炎的病原学特点及相关危险因素进行分析。结果痰培养结果显示,病原菌分布主要以革兰阴性菌为主119株占76.3%,革兰阳性菌24株占15.4%,真菌13株占8.3%,创面分泌物结果显示,分离病原菌175株,革兰阴性菌中主要以铜绿假单胞菌(48株占27.4%)和不动杆菌属(19株占14.7%)为主,革兰阳性菌主要以金黄色葡萄球菌(28株占16.0%)为主,真菌以白念珠菌(10株占5.7%)为主;危险因素的研究结果显示,患者年龄偏大、烧伤程度严重、合并吸入性肺炎以及侵入性操作是HAP患者感染的独立危险因素(P<0.05)。结论详细了解烧伤感染患者病原学的分布,并依据病原菌的特点进行抗菌药物的选择,尽量避免胃肠道食管的反流及减少相关侵入性操作的次数,加强培养护理人员无菌观念,及时处理烧伤患者的创面,对于改善患者预后和提高治疗效果有着很大的帮助,值得临床推广。

OBJECTIVE To explore the pathogenic characteristics of hospital acquired pneumonia in burned patients and analyze the risk factors,so as to provide references for clinicians in the prevention and treatment of hospital acquired pneumonia.METHODS A total of 1320 cases of burned patients admitted in the hospital from Jan.2012 to Jul.2015 were selected,and pathogenic characteristics and risk factors of hospital acquired pneumonia were analyzed.RESULTS From the results of sputum culture,the distribution of pathogens were mainly gram-negative bacteria （119 strains,76.3%）,gram-positive bacteria （24 strains,15.4%）,and fungi （13 strains,8.3%）.From the results of wound secretions,175 strains of pathogenic bacteria vere isolated,the main gram-negative bacteria were Pseudomonasaeruginosa （48 strains,27.4%） and Acinetobacter （19 strains,14.7%）,the main gram-positive bacteria was Staphylococcus aureus （28 strains,16.0%）,and the main fungus was Candida albicans （10 strains,5.7%）.The risk factors analysis showed that,older age,the severe burn,combination with aspiration pneumonia and invasive operation were independent risk factors for HAP infection （P〈0.05）.CONCLUSION Understanding the distribution of pathogens in patients with burn infection,selecting the antimicrobial agents according to the characteristics of pathogens,avoiding the gastrointestinal esophageal reflux and reducing the number of related invasive operation,strengthening the aseptic concept of nursing staff,and timely treating wounds of burned patients,have a great help to improve the prognosis of patients and improve the treatment effect,which are worthy of clinical promotion.