不同程度颅脑损伤气管切开患者药物雾化吸入治疗的肺部感染状况分析

Analysis of pulmonary infection in patients with different degrees of traumatic brain injury and tracheotomy based on drug inhalation

目的:分析不同程度颅脑损伤气管切开患者药物雾化吸入治疗的肺部感染状况。方法:回顾性分析2017年1月至2018年1月收治的中度(n=90例)和重度(n=90例)颅脑损伤患者的治疗情况。按照气管切开后治疗方式的不同,将中度和重度患者分为气管滴药组(n=90例)和雾化吸入组(n=90例)。观察患者治疗7 d、14 d和21 d后,细菌阳性率、痰量、病原菌分布及并发症情况的变化差异。结果:中度颅脑损伤患者治疗7 d、14 d和21 d后,气管滴药组的细菌阳性率及痰量指标高于雾化吸入组,差异具有统计学意义(P <0. 05);而重度颅脑损伤患者治疗7 d、14 d和21 d后,气管滴药组的细菌阳性率、痰量指标低于雾化吸入组,差异具有统计学意义(P <0. 05);对于重度颅脑损伤患者,气管滴药组与雾化吸入组的革兰阳性菌、真菌、结核杆菌等分布情况差异无统计学意义(P> 0. 05),而气管滴药组的革兰阴性菌高于雾化吸入组,差异具有统计学意义(P <0. 05);对于中重度颅脑损伤患者,其气管滴药组与雾化吸入组的并发症发生率比较差异无统计学意义(P> 0. 05)。结论:气管滴药法对重度颅脑损伤患者的疗效明显,可防止肺部感染,而雾化吸入法则对中度颅脑损伤患者的应用效果较为明显。

Objective： To study pulmonary infection in patients with different degrees of traumatic brain injury and tracheotomy based on drug inhalation. Methods： 180 patients with different degrees of traumatic brain injury and tracheotomy were divided into severe brain injury（ 90 cases）and moderate brain injury（ 90 cases）. Patients with severe/moderate brain injury were divided into tracheal drip group（ 90 cases） and inhalation group（ 90 cases） respectively,according to different treatment methods after tracheotomy. Changes in bacterial positive rate,sputum volume,distribution of pathogenic bacteria and complications were observed after 7 d,14 d and 21 d of treatment. Results： After 7 d,14 d,and 21 d of treatment in patients with moderate craniocerebral trauma,the bacterial positive and sputum levels in the tracheal drip group were significantly higher than those in the nebulized inhalation group（ P 〈 0. 05）; for patients with severe craniocerebral trauma after 7 d,14 d and 21 d of treatment,the bacterial positive and sputum levels in the tracheal drip group were significantly lower than those in the nebulized group,with a significant difference（ P 〈 0. 05）. For patients with severe head injury,there was no significant difference in the distribution of Gram-positive bacteria,fungi,and mycobacterium tuberculosis,between the tracheal instillation group and the inhalation group（ P 〉 0. 05）; and in the trachea drip group,the gram-negative bacteria（ 23. 3 %） was significantly higher than that of the aerosol inhalation group（ 8. 8 %）,and the difference was statistically significant（ P 〈 0. 05）. For patients with moderate to severe traumatic brain injury,the incidence of complications in the tracheal drip group and inhalation group did not change significantly,and the difference was not statistically significant（ P 〉 0. 05）. Conclusion： Tracheal drips of medicine for the treatment of patients with severe craniocerebral injury is more significant,which can prevent lung infection,and nebulization inhalation rule for the application of patients with moderate craniocerebral injury is more obvious.