重型颅脑损伤并发颅内感染患者肺部感染的影响因素及病原学特点

Influencing factors and etiological characteristics of pulmonary infection in severe craniocerebral injury patients complicated with intracranial infection

目的分析重型颅脑损伤并发颅内感染患者肺部感染的影响因素,并制定相关护理对策,为临床提供指导。方法选择2015年5月-2017年10月医院收治的144例重型颅脑损伤并发颅内感染患者为研究对象,其中发生肺部感染患者21例作为研究组,未发生肺部感染患者123例作为对照组。回顾性分析两组患者性别、年龄、损伤类型、合并症等临床资料,单因素及多因素Logistic回归分析患者发生肺部感染的影响因素,采集感染患者临床标本,应用全自动微生物分析仪进行病原菌鉴定和药敏试验。结果年龄>50岁、有吸烟史、开放性损伤、多发损伤、合并症>2个、昏迷>2d、气管切开、住院治疗时间>20d是重型颅脑损伤并发颅内感染患者发生肺部感染的影响因素;21例感染患者共检出23株病原菌,其中,革兰阳性菌6株占26.09%,以金黄色葡萄球菌为主,革兰阴性菌15株占65.22%,以铜绿假单胞菌、鲍氏不动杆菌为主,真菌2株占8.7%;主要革兰阳性菌未检出对万古霉素耐药菌株;主要革兰阴性菌对哌拉西林/舒巴坦、美罗培南、阿米卡星、左氧氟沙星的耐药株数较少。结论重型颅脑损伤并发颅内感染患者肺部感染风险较高,革兰阴性菌是肺部感染主要病原菌,需根据病原菌具体分布及药敏情况采用合理抗菌药物以及相关护理干预措施,以增强治疗效果,避免感染加重,促进康复进程。

OBJECTIVE To explore the influencing factors for pulmonary infection in severe craniocerebral injury patients complicated with intracranial infection and put forward the nursing countermeasures so as to provide guidance for clinical treatment.METHODS A total of 144 severe craniocerebral injury patients complicated with intracranial infection who were treated in the hospital from May 2015 to Oct 2017 were recruited as the study objects,21 patients who had pulmonary infection were assigned as the study group,and 123 patients who did not have pulmonary infection were set as the control group.The clinical data of the two groups of patients,including genders,age,types of injury and complications,were retrospectively analyzed;univariate analysis and multivariate logistic regression analysis were performed for the influencing factors for the pulmonary infection,the clinical specimens were collected from the patients with infection,the isolated pathogens were identified by using automatic microorganism analyzer,and the drug susceptibility testing was carried out.RESULTS The influencing factors for pulmonary infection in the severe craniocerebral injury patients complicated with intracranial infection included more than 50 years of age,smoking history,open injury,multiple injuries,more than 2 complications,coma more than 2 days,tracheotomy and length of hospital stay more than 20 days.Totally 23 strains of pathogens were isolated from 21 patients with infection,6(26.09%)of which were gram-positive bacteria,15(65.22%)were gram-negative bacteria,and 2(8.7%)were fungi.Staphylococcus aureus was the predominant species of the grampositive bacteria;Pseudomonas aeruginosa and Acinetobacter baumannii were dominant among the gram-negative bacteria.Among the major species of the gram-positive bacteria,no vancomycin-resistant strains were detected.Among the major species of the gram-negative bacteria,few strains were resistant to piperacillin-sulbactam,meropenem,amikacin or levofloxacin.CONCLUSIONThe severe craniocerebral injury patients complicated with intracranial infection are at high risk of pulmonary infection,the gram-negative bacteria are dominant among the pathogens causing the pulmonary infection.It is necessary to reasonably use antibiotics based on the distribution of pathogens and result of drug susceptibility testing so as to boost the therapeutic effect,prevent the aggravation of the infection and promote the rehabilitation.