颅脑损伤并发肺部感染的病原菌分布、药物敏感试验结果及高压氧联合支气管肺泡灌洗的治疗效果

Pathogen Distribution and Drug Sensitivity Test Results of Craniocerebral Injury Complicated with Pulmonary Infection and Therapeutic Effect of High Pressure Oxygen Combined with Bronchoalveolar Lavage

目的:了解颅脑损伤并发肺部感染的病原菌分布、药物敏感试验结果,并探讨高压氧联合支气管肺泡灌洗治疗颅脑损伤并发肺部感染的效果。方法:选取2017年1月至2019年6月首都医科大学附属北京友谊医院平谷医院收治的重度颅脑损伤并发肺部感染患者96例,对其感染病原菌分布、药物敏感率进行分析。按照随机数字表法将患者分为研究组和对照组,每组48例。对照组患者给予支气管肺泡灌洗治疗,研究组患者给予高压氧联合支气管肺泡灌洗治疗,比较两组患者的治疗效果。结果:共分离出215株病原菌,其中141株为革兰阴性菌(占65.58%),66株为革兰阳性菌(占30.70%),8株为真菌(占3.72%)。药物敏感试验结果显示,主要革兰阴性菌对头孢哌酮舒巴坦、亚胺培南的敏感率相对较高,对哌拉西林、头孢哌酮及头孢他啶的敏感率相对较低;主要革兰阳性菌对复方磺胺甲唑、万古霉素的敏感率相对较高,对青霉素、阿奇霉素、环丙沙星、克林霉素及头孢唑林的敏感率相对较低。治疗后,两组患者动脉血氧分压(PaO2)水平、格拉斯哥昏迷评分(Glasgow coma scale,GCS)明显升高,且研究组患者的PaO2水平、GCS评分明显高于对照组,差异均有统计学意义(P <0.05)。研究组患者治疗总有效率为95.83%(46/48),与对照组的81.25%(39/48)比较,明显较高,差异有统计学意义(P <0.05)。结论:颅脑损伤并发肺部感染的主要病原菌为革兰阴性菌,药物敏感试验结果可指导合理应用抗菌药物;采用高压氧联合支气管肺泡灌洗治疗颅脑损伤并发肺部感染,可有效提高治疗效果。

OBJECTIVE:To explore the pathogen distribution and drug sensitivity test results of craniocerebral injury complicated with pulmonary infection,and probe into the therapeutic effect of high pressure oxygen combined with bronchoalveolar lavage in the treatment of craniocerebral injury complicated with pulmonary infection.METHODS:Totally 96 patients with severe craniocerebral injury complicated with pulmonary infection admitted into Pinggu Hospital of Beijing Friendship Hospital Affiliated to Capital Medical University from Jan.2017 to Jun.2019 were selected and analyzed in terms of pathogen distribution and drug sensitivity.These patients were divided into research group and control group via random number table,with 48 cases in each group.The control group was given bronchoalveolar lavage for treatment,while the research group was given high pressure oxygen combined with bronchoalveolar lavage for treatment,so that the therapeutic effect was compared between two groups.RESULTS:Totally 215 strains of pathogenic bacteria were isolated,of which 141 strains were gram-negative bacteria(65.58%),66 strains were gram-positive bacteria(30.70%),8 strains were fungus(3.72%).The drug sensitivity test indicated that the major gram-negative bacteria were relatively more sensitive to cefoxitin/sulbactam and imipenem,while less sensitive to piperacillin,cefoperazone and cefotaxime;the major gram-positive bacteria were relatively more sensitive to compound sulfamethoxazole tablets and vancomycin,while less sensitive to penicillin,azithromycin,ciprofloxacin,clindamycin and cefazolin.The arterial partial pressure of oxygen(PaO 2)level and Glasgow coma score(GCS)of patients in both groups were significantly higher after treatment,and the PaO 2 level and GCS score of patients in the research group were significantly higher than those in the control group,with statistically significant differences(P<0.05).The total effective rate of the research group was 95.83%(46/48),which was significantly higher than that of the control group(81.25%,39/48),with statistically significant difference(P<0.05).CONCLUSIONS:The main pathogenic bacteria of craniocerebral injury complicated with pulmonary infection are gram-negative bacteria,the drug sensitivity test can guide the rational application of antibiotics;the application of high pressure oxygen combined with bronchoalveolar lavage can effectively improve the therapeutic efficacy in the treatment of patients with craniocerebral injury complicated with pulmonary infection.