气管切开初期院内下呼吸道感染的探讨

Nosocomial Lower Respiratory Tract Infection in Patients in Early Stage after Tracheotomy

目的 探讨气管切开术与院内下呼吸道感染之间的相关性。方法 监测 4 7例非肺部感染患者中行气管切开术后最初 4 d内发生下呼吸道感染的相关因素、呼吸道感染菌群的特点及其耐药性及与机械通气的关系。结果 术后 4 d内 ,4 7例患者中发生院内下呼吸道感染的有 17例 ,占 36 % ;17例患者气道分泌物培养获得致病菌 2 4株 ,均为多重耐药菌 ;4 7例患者中发生医院感染者与未发生医院感染者比较 :医院感染组有慢性阻塞性肺部疾病 (COPD)史者、手术时低蛋白血症者及术前抗生素的使用比例高于无医院感染组。结论 院内下呼吸道感染的发生与患者的 COPD史、手术时低蛋白血症等有一定关系 ;术前抗生素的高使用状况可能与致病菌的高度耐药有关。

OBJECTIVE To explore the nosocomial lower respiratory infection in patients with tracheotomy. METHODS To observe the correlative factors, distribution and antibacterial resistance of pathogens from the patients with lower respiratory tract infection in early stage after tracheotomy. RESULTS The results showed that from 47 patients 17 patients (approximetely 36%) suffered nosocomial lower respiratory tract infection four days after tracheotomy. A total of 24 strains from 17 nosocomial infection cases were isolated, from which the multi resistance bacilli were predominant. The rate of COPD history and antibiotic used were higher in patients with nosocomial lower respiratory tract infection. The level of albumin in serum of the patients with nosocomial lower respiratory tract infection was lower than that without nosocomial infection (P<0.05). CONCLUSIONS The history of COPD, hypoproteinemia, and the wide use of broad spectrun antibiotics were associated with occurrence and development of nosocomial lower respiratory tract infection.