脑出血术后患者并发肺部感染分析  

Pulmonary infections among patients after surgery of intracerebral hemorrhage

作　　者：林建虎[1] 卢艳艳[2] 陆川[1] 孙军[1] 

机构地区：[1]温州市第二人民医院神经外科,浙江温州325000 [2]温州市第二人民医院重症监护室,浙江温州325000

出　　处：《中华医院感染学杂志》2013年第9期2060-2061,共2页Chinese Journal of Nosocomiology

摘　　要：目的对脑出血术后患者肺部感染的发生率、易感因素及病原菌构成进行分析,探讨防治措施。方法对172例脑出血术后患者进行医院感染调查。结果 47例发生肺部感染,感染率为27.3%;<60岁感染率为15.6%、>60岁感染率为42.1%,昏迷>7d感染率为62.7%、<7d感染率为4.8%,既往肺部疾病或吸烟史感染率为43.3%,否认肺部疾病及吸烟史者为9.8%,糖尿病史或监测血糖>11.2mmol/L感染率为34.4%,无明显血糖升高者8.5%,术前呕吐伴误吸者感染率58.3%,无呕吐误吸者10.7%,上述各组间均使用χ2检验,差异有统计学意义(P<0.05);由患者痰标本经细菌学检验分离出病原菌112株,阳性例数较多的为革兰阴性菌,敏感的抗菌药物为美罗培南、头孢哌酮/舒巴坦等。结论脑出血术后患者容易并发肺部感染,主要危险因素有年龄、术后昏迷时间、肺部疾病或吸烟史、糖尿病史或高血糖及术前呕吐误吸等,应针对易感因素做好预防措施,并注意抗菌药物合理应用。OBJECTIVE To analyze the incidence of pulmonary infections,the predisposing factors of bacterial colony changes,and the constituent ratios of pathogenic bacteria so as to discuss the prevention counter measures.METHODS A total of 172 cerebral hemorrhage patients who underwent craniotomy or hemorrhage drainage surgery were investigated for the incidence of the nosocomial infections.RESULTS The pulmonary infections occurred in 47 patients with the infection rate of 27.3%.The infection rate of the patients with less than 60 years of age was 15.6%,the patients with more than 60 years of age 42.1%,the patients with coma more than 7 days 62.7%,the patients with the coma less than 7 days 4.8%,the patients with lung diseases or smoking history 43.3%,the patients denying the lung diseases or smoking history 9.8%,the patients with diabetes or the blood glucose level higher than 11.2 mmol/L 34.4%,the patients without significantly elevated blood glucose 8.5%,the patients with preoperative vomiting 58.3%,and the patients without vomiting 10.7%,all the data of each group were analyzed statistically by the χ2 test,the difference was statistically significant（P0.05）.A total of 112 strains of pathogens were isolated through the bacteriological detection of the sputum specimens,the majority of which were the gram-negative bacteria and were sensitive to meropenem,cefoperazone/sulbactam.CONCLUSION The patients after operation of intracerebral hemorrhage are prone to the pulmonary infections.The age,postoperative coma time,lung diseases or smoking history,diabetes or high blood glucose,and preoperative vomiting are the main risk factors.It is necessary to develop the prevention measures in response to the predisposing factors and to reasonably use antibiotics.

关 键 词：肺部感染 脑出血 术后 

分 类 号：R563.1[医药卫生—呼吸系统]