吞咽功能训练降低颅脑损伤气管切开患者肺部感染的临床研究

Clinical effect of swallowing function training on reducing lung infection in craniocerebral injury patients with tracheotomy

目的探讨吞咽功能训练降低颅脑损伤气管切开患者肺部感染的临床疗效。方法选择124例颅脑损伤患者,按照随机数字法分为实验组与对照组,对照组采取常规治疗,实验组则在对照组的基础上采取吞咽功能训练,采集2组肺部感染患者分泌物标本进行细菌培养、鉴定及药敏实验,并比较2组患者吞咽功能、肺部感染率及置管时间。结果通过培养、分离共从43例肺部感染患者中检出223株病原菌,其中革兰阳性菌65株(29.15%),革兰阴性菌148株(66.37%),真菌18株(8.07%)。金黄色葡萄球菌对青霉素G、氨苄西林的耐药率均>87%,对万古霉素、利福平、克林霉素敏感;粪肠球菌对环丙沙星、青霉素G耐药;表皮葡萄球菌对万古霉素、利福平、克林霉素敏感。鲍氏不动杆菌、铜绿假单胞菌、肺炎克雷伯菌对头孢他啶、头孢噻肟、氧氟沙星均有较高的耐药率,而对亚胺培南、美罗培南敏感;而鲍氏不动杆菌及肺炎克雷伯均对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦耐药率<30%;铜绿假单胞菌具有耐药较为广泛,仅对亚胺培南、美罗培南敏感。治疗后,实验组优良率显著优于治疗前及对照组(P<0.05)。实验组肺部感染率及置管时间均显著优于对照组(P<0.05)。结论颅脑损伤气管切开患者行吞咽功能训练有效可降低肺部感染,缩短置管时间,改善预后。

Objective To explore clinical efficacy of swallowing function training in reducing lung infection in craniocerebral injury patients with tracheotomy. Methods A total of 124 craniocerebral injury patients in the hospital were randomized into experimental group and control group, the control group received conventional treatment, while the experimental group took swallowing function training based on the control group, secretion samples of pulmonary infection patients were collected for bacterial culture, identification and susceptibility test, and swallowing, lung infection rate and catheter indwelling time were compared. Results There were 223 strains of pathogens detected in 43 patients with lung infection after culture and isolation, including 65 strains（29.15% ） of gram-positive bacteria, 148 （66.37%） of gram-negative bacteria, and 18 （8.07%） of fungus. The resistance rates of staphylococcus aureus to penicillin G, ampicillin were more than 87%, and was sensitive to vancomycin, rifampin, and clindamycin. Enterococcus faecalis was resistant to ciprofloxacin, and penicillin G. Staphylococcus epidermidis cocci was sensitive to vancomycin, rifampin, clindamycin. Acinetobacter baumannii, pseudomonas aeruginosa, Klebsiella pneumoniae had higher resistance to ceftazidime, cefotaxime, and ofloxacin, whereas was sensitive to imipenem, and meropenem. And resistance rates of Acinetobacter baumannii and Klebsiella pneumoniae to piperacillin/tazobactam, and cefoperazone/sulbactam were less than 30%; Pseudomonas aeruginosa had wide range of drug resistance , but was sensitive to imipenem , and meropenem only. After treatment , excellent rate in the experimental group was significantly better than the treatment before and the control group （P 〈 0. 05） Experimental group had less lung infection and less catheter indwelling time than the control group （P 〈 0.05 ）. Conclusion Swallowing training for craniocerebral injury patients with tracheotomy can effectively reduce lung infection, shorten catheter indwelling time, and improve the prognosis.