气管切开患者肺部感染的病原菌分析及预防治疗  

Pathogens causing pulmonary infection in patients after tracheotomy and preventive treatment

作　　者：许立民[1] 孔磊[1] 盘晓荣[1] 俸道荣[1] 黄剑平[1] 樊秋萍[1] 谢金萍[1] 

机构地区：[1]广西壮族自治区人民医院高压氧科,广西南宁530021

出　　处：《中华医院感染学杂志》2011年第24期5287-5290,共4页Chinese Journal of Nosocomiology

基　　金：广西壮族自治区医疗卫生自筹经费计划课题(Z2008069)

摘　　要：目的了解重型颅脑损伤气管切开后肺部感染的病原菌特征及耐药性,提出预防治疗措施。方法对60例重型颅脑损伤气管切开术后肺部感染患者进行前瞻性调查,对患者的痰及下呼吸道分泌物进行病原菌培养和药敏试验,并统计分析。结果 60例肺部感染患者病原菌以革兰阴性杆菌为主,占72.6%,真菌占第2位,占14.1%,前4位的病原菌依次是鲍氏不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌,分别占21.2%、19.5%、11.5%、6.2%;鲍氏不动杆菌和肺炎克雷伯菌对哌拉西林、头孢他啶、头孢噻肟、头孢唑林、头孢哌酮、氨苄西林、氨曲南、环丙沙星、氧氟沙星、庆大霉素、四环素、氯霉素的耐药率均>50.0%。结论重型颅脑损伤气管切开术后肺部感染以革兰阴性杆菌为主,耐药性高;临床应根据药敏合理使用抗菌药物,给予早期高压氧治疗,加强呼吸道管理,防止医院感染,以利于肺部感染控制。OBJECTIVE To understand the characteristics and drug sensitivity of pathogens causing pulmonary infection in patients with severe brain injury and tracheotomy and to explore preventive measures. METHODS A total of 60 patients with pulmonary infection after severe brain injury and tracheotomy were included in the prospective study. Phlegm and excretion of lower respiratory tract culture was performed, as well as drug susceptibility test. The results were statistically analyzed. RESULTS Among the pathogens isolated from 60 patients with pulmonary infection, 72.5% were gram-negative bacilli and 14.1% were fungi. The most common pathogenic bacteria were Acinetobacter baurnannii （21.2 % ）, Pseudornonas aeruginosa （ 19.5 % ）, Klebsiella pneu- rnoniae （11.5 %） and Escherichia coli （6. 2 %）. The drug susceptibility test showed A. baumannii and K. pneu- moniae were resistant to piperacillin, ceftazidime, cefotaxim, cefazolin, cefoperazone, Ampicil, aztreonam, ciprofloxacin, Ofloxacin, Gentamicin, ambramycin and alficetin, with resistance rates of more than 50. 0%. CONCLUSION The main pathogens in pulmonary infection after severe brain injury and tracheotomy are Gram- negative bacilli with high resistance rate. It is important to rationally use antibiotics according to drug susceptibility, begin hyperbaric oxygen treatment as soon as possible, enhance the respiratory management and prevent cross-infection for control of pulmonary infection.

关 键 词：重型颅脑损伤 气管切开 肺部感染 病原菌 耐药性 高压氧 

分 类 号：R378[医药卫生—病原生物学]