气管插管高血压脑出血患者呼吸道致病菌分布特点分析

Analysis of the distribution characteristics of pathogenic bacteria in the respiratory tract of patients with hypertensive cerebral hemorrhage undergoing tracheal intubation

目的分析气管插管高血压脑出血患者呼吸道致病菌分布特点,为医院院感工作提供依据。方法对2017年1月~2019年12月辽宁省健康产业集团铁煤总医院收治的588例接受气管插管辅助通气高血压脑出血患者的临床资料进行回顾性分析,取发生呼吸道感染患者的呼吸道分泌物,进行病原学分析,将定量培养液浓度≥107 CFU/mL的病原体定为气道内致病菌。结果588例患者,共314例发生呼吸道院内感染,感染率为53.40%。3年期间,共培养出菌株2808株,其中革兰氏阳性菌(G+菌)422株(15.03%),革兰氏阴性菌(G-菌)1854株(66.03%),念珠菌527株(18.95%),其他5株(0.18%)。422株G+菌中,最多见的为金黄色葡萄球菌,共250株,且呈逐年上升趋势,其次是溶血性葡萄球菌和表皮葡萄球菌;1854株G-菌中,最常见的是铜绿假单胞菌,共545株,且每年的比例较为稳定,其次是肺炎克雷伯菌,所占比例呈逐年下降趋势。结论气管插管的高血压脑出血患者是呼吸道感染的高危人群,对其病原学特点进行分析,准确掌握其迁移特点,对有效控制院内呼吸道感染具有重要意义。

Objective To analyze the distribution characteristics of respiratory tract pathogenic bacteria in patients with hypertensive cerebral hemorrhage undergoing tracheal intubation,so as to provide a basis for hospital infection work.Methods The clinical data of 588 patients with hypertensive cerebral hemorrhage who received endotracheal intubation assisted ventilation from January 2017 to December 2019 in Iron Coal General Hospital of Liaoning Health Industry Group were retrospectively analyzed.The patients took respiratory tract secretions for pathogenic analysis,and the pathogens with a quantitative culture concentration of≥107 CFU/mL were designated as pathogens in the airway.Results There were 314 cases of respiratory tract nosocomial infection in 588 patients,the infection rate was 53.40%.During 3 years,2808 strains were cultured,among which Gram-positive bacteria(G+bacteria)422 strains(15.03%),Gram-negative bacteria(G-bacteria)1854 strains(66.03%),527 strains(18.95%)of candida and 5 strains(0.18%)of others.Among the 422 strains of G+bacteria,the most common was Staphylococcus aureus,with a total of 250 strains,and the trend was increasing year by year,followed by Staphylococcus hemolyticus and Staphylococcus epidermidis.Among the 1854 strains of G-bacteria,the most common was Pseudomonas aeruginosa,with a total of 545 strains,and the annual ratio was relatively stable,followed by Klebsiella pneumoniae,the proportion of which decreased year by year.Conclusion The hypertensive intracerebral hemorrhage patients undergoing tracheal intubation are a high-risk group of respiratory tract infections.It is important to analyze the etiological characteristics and accurately grasp their migration characteristics to effectively control nosocomial respiratory tract infections.