重症颅脑外伤患者呼吸系统的细菌感染及预防措施

STUDY ON BACTERIAL INFECTION AND PREVENTIVE MEASUREMENT OF RESPIRATOR Y SYSTEM AMONG THE PATIENTS OF SERIOUS BRAIN'S INJURY .

目的 :研究重症颅脑外伤患者气管插管后呼吸系统细菌学分布特点及预防措施。方法 :ASA(美国麻醉医师协会 ) ～ 级重症颅脑外伤患者 2 0例 ,气管插管后行机械通气 ,分别在第 1d,3 d,5 d,7d选取口咽部标本、气管导管末端标本 ,接种在 MH琼脂平板和巧克力平板 ,3 5℃培养 18～ 2 4h。所有细菌使用 IMS细菌鉴定药敏分析系统鉴定。结果 :肺炎克雷伯氏菌检出高峰期在 3～ 5 d,检出阳性率 11.66% ;铜绿假单胞菌和真菌检出高峰期在 5～ 7d,检出阳性率分别为 12 %和 6.3 3 % ,总检出阳性 14 4次 ,占 48%。结论 :重症颅脑外伤患者气管插管后呼吸系统相关细菌以肺炎克雷伯氏菌、大肠埃希菌、铜绿假单胞菌感染率最高 。

Objective:To study the bacterial distribution,the methods of prevention and treatment of nosocomial pulmonary infection of the pat ients of serious brains injury.Methods:Twenty ASA Ⅲ～Ⅳ patients of serious brains injury were intubated before mechanical ventilation.Samples on culture medium from the oropharynx and lower respiratory tract were obtained, and then identified by IMS on the 1st,3rd,5th,7th day,then culture at 35℃ from 18 hours to 24 hours.Results:According to the distribution of bacteria,tota l of 300 times were checked,among them 144 times were positive.The important pathogens of them were klebsiella pneumoniae(positive rate 11 66%),pseudomonas aeruginosa(positive rate 12%),fungus(positive rate 6 33%).Conclusion:The management of respiratory system,the digestive system and the reasona ble use of antibiotics are very important to prevent and control the nosocomial infection.