重型颅脑损伤患者气管切开术后肺部感染原因分析及对策  

Causes of postoperative pulmonary infections in severe traumatic brain injury patients undergoing tracheotomy and prevention countermeasures

作　　者：李妍[1] 曾萍[2] 

机构地区：[1]新乡医学院第一附属医院神经外科,河南卫辉453100 [2]新乡医学院第一附属医院重症医学科,河南卫辉453100

出　　处：《中华医院感染学杂志》2014年第2期438-440,共3页Chinese Journal of Nosocomiology

基　　金：河南省教育厅自然科学研究基金项目(12A320012)

摘　　要：目的探讨重型颅脑损伤患者气管切开术后肺部感染原因及其对策,为其治疗及预防提供依据。方法选取2010年2月-2012年9月医院行气管切开术的53例重型颅脑损伤患者为研究对象,将其中不同年龄、昏迷时间、慢性基础疾病、吸烟史及脑损伤类型者肺部感染率进行比较,分析肺部感染者的病原菌分布,同时对肺部感染患者进行针对性处理,对感染患者的预后情况进行统计分析。结果 53例重型颅脑损伤患者中发生肺部感染27例,感染率为50.94%,其中≥60岁者、昏迷时间≥1周、伴发慢性基础疾病、有吸烟史者及脑挫裂伤患者的肺部感染率分别为69.23%、72.22%、73.33%、67.86%及63.33%,明显高于其他患者,差异均有统计学意义(P<0.05);27例肺部感染患者中共分离病原菌28株,其中革兰阴性菌17株占60.71%,革兰阳性菌9株占32.14%,真菌2株占7.14%。结论年龄较大、昏迷时间较长、伴发慢性基础疾病、有吸烟史及脑挫裂伤为重型颅脑损伤患者气管切开术后肺部感染的重要原因,且以革兰阴性菌感染为主,经针对性处理可有效控制感染。OBJECTIVE To explore the causes of pulmonary infections in the patients with severe traumatic brain in- jury after tracheotomy and put forward prevention countermeasures so as to guide the clinical treatment. METHODS A total of 53 patients with severe traumatic brain injury, who were treated with tracheotomy in the hospital from Feb. 2010 to Sep. 2012, were selected as the research objects,then the incidence of pulmonary infec- tions in the patients with different age, coma time,chronic underlying diseases,history of smoking, and types of brain injuries were compared, the distribution of the pathogens causing pulmonary infections was analyzed, the tar- geted nursing was carried out, and the clinical outcomes were statistically analyzed. RESULTS A total of 27 cases with pulmonary infection were found in 53 cases patients with severe brain injury, and the infection rate was 50.94%. The incidence of pulmonary infections was 69.23% in the patients with more than 60 years of age, 72.22% in the patients with the coma time more than 1 week, 73.33% in the patients complicated with chronic underlying disease, 67.86% in the patient with history of smoking, 63.33% in the patients with cerebral contu- sion and laceration, significantly higher than those of other patients（P〈0.05）. Totally 28 strains of pathogens ha- ven been isolated from the 27 cases of pulmonary infections, including 17 （60.71%） strains of gram-negative bac- teria, 9 （32.14 %） strains o{ gram-positive bacteria, and 2 （7.14 %） strains of fungi. CONCLUSION The advanced age,long coma time, complication of chronic underlying disease, history of smoking, and cerebral contusion and laceration are the main causes of pulmonary infections in the patients with severe traumatic brain injury after trach- eotomy; the gram-negative bacteria are the predominant species of pathogens causing the infections; the infections can be effectively under control through targeted interventions.

关 键 词：重型颅脑损伤 气管切开 肺部感染 

分 类 号：R563.1[医药卫生—呼吸系统]