重型颅脑损伤气管切开患者肺部感染的临床调查  

Clinical study on lung infections in patients received tracheotomy after severe crainocerebral injury

作　　者：余果[1] 王尔松[1] 姚慧斌[1] 

机构地区：[1]复旦大学附属金山医院神经外科,上海201508

出　　处：《中华医院感染学杂志》2015年第14期3263-3265,共3页Chinese Journal of Nosocomiology

基　　金：上海市卫生局科技基金资助项目(2012-339);上海市金山区卫生局科研基金资助项目(JKSJ-KTMS-2013-04)

摘　　要：目的总结分析重型颅脑损伤患者气管切开后发生肺部感染的防治经验,为控制患者肺部感染提供试验数据,促进抗菌药物的合理使用。方法对2009-2013年住院颅脑损伤气管切开的216例患者进行调查分析,对病原学标本进行细菌培养和药敏试验,调查肺部感染的相关危险因素;病原菌培养与鉴定按照《全国临床检验操作规程》进行,药敏试验采用K-B法进行操作和结果判断。结果 216例患者中发生肺部感染161例,发生率74.5%;痰培养出540株病原菌,以革兰阴性杆菌为主,398株占73.7%,其中大肠埃希菌146株,占27.0%,肺炎克雷伯菌78株,占14.4%,铜绿假单胞菌52株占9.6%,对亚胺培南、阿米卡星的敏感度较高;共检出革兰阳性菌142株占26.3%,其中金黄色葡萄球菌62株占11.5%,MASA检出率为53.2%。结论气管切开后发生肺部感染病原菌的来源主要是外源性,以革兰阴性杆菌为主,应及时行痰培养及药敏试验,合理应用抗菌药物,减低临床感染发生率。OBJECTIVE To sum up the preventive experience in lung infected patients received tracheotomy after severe crainocerebral injury so as to provide experimental data for control of lung infections and promote the reasonable use of antibiotics.METHODS Totally 216 cases with cranio cerebral injury patients and received tracheotomy from 2009 to 2013were investigated by bacterial culturing and drug susceptibility tests.The risk factors related to lung infections were also investigated.Pathogen culture and identification were in accordance with the National Guide to Clinical Laboratory Procedures,and the drug susceptibility test was performed by K-B methods recommended by CLSI.The testing results were assessed.RESULTS A total of 161 patients had pneumonia and the infection rate was 74.5%.Totally 540 strains of pathogens were isolated including 398 strains of gram-negative bacteria,accounting for 73.7%;and 146 strains of Escherichia coli,holding 27.0%.Klebsiella pneumonia had 78 strains,accounting for 14.4%.Pseudomonas aeruginosa with 52 strains accounted for 9.6%.They were highly sensitive to imipenem and amikacin.Totally 142（26.3%）strains of gram-positive bacteria were isolated,among which there were 62（11.5%）strains of Staphylococcus aureus.The positive rates of MRSA were 53.2%.CONCLUSION The main pathogenic bacteria causing pulmonary infections of patients with tracheotomy was exogenous,and most of them were gram-negative bacteria.Sputum culture and drug sensitivity test should be conducted in time so that antibiotics can be chosen accordingly to reduce infection rate.

关 键 词：颅脑损伤 气管切开 肺部感染 危险因素 预防控制 

分 类 号：R563.1[医药卫生—呼吸系统]