高血压自发性脑内血肿气管切开后肺部感染的病原菌变化和耐药分析  

Analysis on Drug Resistance and Pathogenic Bacteria Variation of Hospital Lung Infection After Tracheotomy of Hypertensive Spontaneous Intracranial Hemorrhage

作　　者：罗东辉[1] 张小宁[1] 马建华[1] 罗坤[1] 

机构地区：[1]新疆医科大学第一附属医院神经内科,新疆乌鲁木齐830054

出　　处：《新疆医学》2012年第7期27-31,共5页Xinjiang Medical Journal

摘　　要：目的:探讨高血压自发脑内血肿患者气管切开后肺部感染的相关因素和病原菌及耐药情况。方法:回顾性分析2009年1月～2011年12月新疆医科大学第一附属医院高血压自发脑内血肿患者气管切开后肺部感染的痰培养、药敏试验临床实验室资料。结果:肺部感染出现在气管切开后3～6天,与脑损害的程度(昏迷、脑疝)有关(P<0.05),与是否使用地塞米松、H2受体拮抗剂及酸泵抑制剂无关(P>0.05)。共培养出291株菌,其中革兰氏阴性杆菌(G-)155株(53.2%)、革兰氏阳性(G+)球菌125株(43%)、真菌11株(3.8%),亚胺培南、头孢哌酮/舒巴坦G-菌细菌耐药率分别为8%和21%;万古霉素对耐甲氧西林金黄色葡萄球菌(MRSA)、耐甲氧西林凝固酶阴性葡萄球菌(MRSCON)及肠球菌属的敏感率均为100%。结论:高血压自发脑内血肿患者气管切开后肺部感染与应用地塞米松、H2受体拮抗剂及酸泵抑制剂无关,与脑损伤程度有关。应在切开后一周之内积极预防和治疗肺部感染。根据药敏分析选择合适的抗菌药物。Objective To discuss the relevant factors causing hospital iniection of lung m patmnts with hy-pertensive spontaneous intracranial hemorrhage after tracheotomy. Methods using retrospective studies to ana- lyze sputum bacteria cultures, drug sensitive tests and relative clinical data of 202 acute cerebral insults pa-tients. Results most infections occurred 3 - 7 days after tracheotomy. It related to the degree of insults, but not to use of drugs such as dexamethasone, H2 receptor antagonist and acid pump inhibitor. Two hundred and nineteen strains of pathogenic bacteria were found, of them 155 gram - negative 、 125 gram - positive and 11 fungi which are all mix infection with bacteria. Conclusions Hospital infection of lung in acute cerebral insults patients after trachcotomy is not relates to use of dexamethasorte, H2 receptor antagonist and acid pump inhibi-tor, but is related to seriousness of insults. Prevention and control should be done within the first week after tracheotomy with active treatment of original disease and selection of antibiotics based on antimicrobial suscep- tibility testing to control nosocomial.

关 键 词：气管切开 急性脑损害 药敏试验 肺部感染 

分 类 号：R655.3[医药卫生—外科学]