神经外科重症监护室老年患者气管切开后肺部感染原因与护理

Analysis of Pulmonary Infection and Nursing Points in Elder Patients After Tracheotomy in Neurosurgical ICU

目的分析神经外科重症监护室(intensive care unit,ICU)内老年患者气管切开后肺部感染原因,总结其护理要点。方法回顾性分析2015年1月至2016年6月安徽省淮北市人民医院收治的颅脑损伤及自发性脑出血行气管切开术后发生肺部感染的老年患者45例的临床资料,分析其气管切开后肺部感染原因及菌谱,并提出护理对策要点。结果 45例患者中,32例接受机械通气治疗,除有6例患者在院外行气管切开术,其余患者在入院治疗期间均行气管切开术。导致肺部感染的前3位致病菌分别为鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌。结论在神经外科ICU中,老年患者气管切开后,肺部感染多为阴性菌感染,并且多重耐药、泛耐药甚至耐碳青霉烯菌株也不少见,应优先采取有效护理对策,减少院内感染机会;一旦发生感染,应尽早获得痰培养及药敏结果,指导临床用药。

Objective To summarize and analyze the reasons of pulmonary infection in elder patients after tracheotomy in neurosurgical intensive care unit（ICU）.Methods Clinical data of totally 45elder patients after tracheotomy with craniocerebral injury and spontaneous intracerebral hemorrhage from January 2015 to June 2016 were analyzed retrospectively.The reasons of pulmonary infection and the spectrum of bacteria were analyzed and the nursing points were summarized. Results There were 45 patients included, 32 of whom were treated with mechanical ventilation.Except 6 patients with pre-hospital tracheotomy.The first three pathogens were Acinetobacterbaumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa. Con- clusion In neurosurgical ICU,pulmonary infections of eider patients mostly were negative bacterial infections,and multi-drug resistance,pan-resistant and even carbapenem-resistant strains are not uncommon.It should give priority to take effective care measures to reduce nosocomial infection opportunities;once infection have occurred, it should be obtained sputum culture and drug sensitivity results as soon as possible, guiding the clinical medication.